Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you treat with high-dose radiation alone (without ADT) for favorable intermediate risk prostate cancer?
We do treat so-called low-intermediate risk prostate cancer with RT alone (brachy alone or high dose IMRT). The critetia we use is GS 3+4, low number of cores being positive, non-palpable disease, and PSA close to 10.The impact of short term androgen ablation with high dose RT is not clearly defined...
What field and dose would you prescribe for a an extra-renal rhabdoid tumor of the pelvis?
Extrarenal, noncerebral rhabdoid tumors are relatively rare. However, the literature indicates an advantage for delivery of radiation therapy. Bourdeaut et al in 2008 reported on 26 patients with extrarenal, noncerebral rhabdoid tumors in whom the only surviving patient who had a proximal limb tumor...
Do you recommend hypofractionated/Canadian fractionation for in-situ ductal cancer?
The same pretzel logic used to deny hypo fractionation to patients with DCIS was used in the 80's to deny them breast conservation. It is not only reasonable to extrapolate the data from over 7000 patients with early stage invasive breast cancer on the British and Canadian trials, it is necessary fo...
Is it safe to offer breast/chest wall radiotherapy while a patient is receiving Perjeta?
I treated a patient for spine met while on Herceptin and perjeta and the side effects were much more extreme than usual. The patient was admitted with radiation esophagus, could not swallow and EGD showed a very deep circumferential ulcer consistent with radiation. In this situation I am convinced t...
In what situations do you recommend adjuvant radiotherapy for colon cancer?
It is appropriate to be cautious when considering the use of CXRT in patients with resected colon cancer. The main reason is that in the post-operative setting there is almost always fixed small bowel adherent to the tumor bed. For this reason, one may not be able to deliver a high enough dose to pr...
When treating bladder cancer with CRT in the bladder preservation paradigm, do you cone down to partial bladder or the whole bladder?
I agree with @Dr. First Last about whole vs. partial bladder "cone-down", although in my experience I'm much less like than @Dr. First Last to treat partial bladder. In addition to the trials mentioned, the old SWOG experience (Combined 5-fluorouracil and irradiation for transitional cell carcinoma ...
Should early referral to palliative care be standard of care for all patients with metastatic cancer?
There are data to support that early palliative care involvement can improve patient quality of life. One study that specifically comes to mind is a study published by Temel et al in NEJM 2010 (http://www.ncbi.nlm.nih.gov/pubmed/20818875) in the setting of metastatic NSCLC. This study randomized pat...
What is the role of radiation consolidation after chemotherapy for residual splenic involvement in follicular lymphoma?
Recommend 3000 cGy in 15 fractions
In evaluating V20 for lung RT, how should the lung volume be defined?
Most of the published data is on both lungs minus PTV. QUANTEC accounts for all normal lung treated minus GTV, and this is what we favor now. There is a small difference in numbers between the two approaches. Attached is a link to a dosimetric study we did in this regard to this to quantify this dif...
Is there a role for anti PD-1/checkpoint inhibitors or other immunotherapies with radiation?
There's a lot of enthusiasm, and fairly little evidence so far. Driving the interest is the observation made over the past several decades, that radiation can induce an immunologic/abscopal response: that by treating one site of disease, a systemic response is initiated that results in responses in ...