Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you recommend holding tyrosine-kinase inhibitors for extracranial metastases being treated with SBRT?
In general, yes I would recommend holding TKIs during SBRT. Anecdotally from both my own experience and others, there is a small risk of severe pneumonitis in patients on concurrent or recent TKI (much of this with osimertinib which has a reasonably high risk of symptomatic pneumonitis on its own) a...
How do you manage a patient who finished chemoRT for head and neck cancer and loses >10% body weight within 2 weeks post-treatment?
Very contextual question. We are all mostly taught that we should avoid feeding tubes at all costs. And this teaching comes from our beloved head and neck attendings at tertiary centers, with inpatient oncology, infusion on site, nutritionists, speech and swallowing specialists, and IR/GI on demand ...
How do you approach definitive radiation in a patient with an indwelling catheter due to obstruction from locally advanced prostate cancer?
This is a situation I encounter several times per year. The answer depends on whether or not I am being consulted strictly for palliation of the obstructive symptoms, or for curative intent therapy. For strictly palliation in a man who has already been on ADT/Abi/Enza/Chemo etc with progression, whe...
What are best practices for oncologists during the national platinum shortage?
In breast cancer, we are prioritizing patients with curable disease in which platinum agents are a critical part of the regimen or have actually shown a clear advantage (the only example of this is shown below in bold).Use an alternative to a carboplatin-based regimen whenever possible. If no altern...
How would you approach post-operative radiation in a patient with ER/PR negative Her2 positive, T1c N0 breast cancer originating in the ectopic mammary tissue close to the axilla, treated wide excision followed by APT regimen (weekly paclitaxel plus trastuzumab with trastuzumab for one year)?
I would approach this case as I would breast conserving surgery and recommend post-operative systemic therapy for T1cN0N0 HER2+ breast cancer - if wide excision with negative margins along with sentinel node biopsy has been done, then I would use the APT regimen (weekly paclitaxel plus trastuzumab w...
If memantine were started 6 weeks after completion of radiation to base of skull, would you expect any potential benefit?
There is currently no credible high-quality data to support the use of memantine in focal brain RT for primary or metastatic brain tumors, regardless of whether the hippocampus is in the radiation field. Therefore, I would not prescribe memantine during or after RT in such a clinical setting. In my ...
In what clinical scenario, if any, would you consider APBI appropriate treatment for a patient with triple-negative breast cancer?
Currently, none of the prospective studies did APBI after neoadjuvant chemotherapy so that subset, we don't offer APBI (need studies in this space).As far as denovo early-stage TNBC, we have not been doing APBI as were only part of one (B39) of all prospective randomized studies with PBI and also sh...
Would you hold CGRP (calcitonin gene-related peptide) monoclonal antibodies such as Eptinezumab-jjmr (Vyepti) before, during, or after lung SBRT?
No, I will not hold CGRP monoclonal antibodies during lung SBRT as at present, there is no data suggesting the detrimental effect of doing so. Moreover, the drug is conveniently given q 3months while SBRT is usually completed within 2 weeks. Therefore, most lung SBRT can be scheduled outside of the ...
What is the best fractionation for head and neck patients who cannot receive systemic therapy due to KPS or medical comorbidities?
In my experience, using the DAHANCA regimen (once daily 4 days a week, twice daily once a week), but treating only PTV1 in the second daily fraction, is quite well tolerated. The original DAHANCA treated all targets twice daily. However, using IMRT it is possible to avoid prophylactically irradiated...
When would you use PSMA PET over conventional imaging for prostate cancer?
So far, most (but not all) prospective data for molecular imaging has been obtained in the setting of biochemical recurrence and that is where I have used it most outside of trials.In the primary disease setting, some trials examined the utility to detect nodal and distant disease (like OSPREY publi...