Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What are your top takeaways from ASTRO 2022?
1. NRG RTOG 1005: A Phase III Trial of Hypofractionated Whole Breast Irradiation with Concurrent Boost vs. Conventional Whole Breast Irradiation Plus Sequential Boost Following Lumpectomy for High Risk Early-Stage Breast Cancer The results showed that with hypofractionation and SIB technique, 7 year...
How do you counsel NSCLC patients receiving SBRT on fatigue?
The first thing is to warn the patient and their family that fatigue is possible, and that it peaks about 2 weeks after treatment ends. I also remind them that SBRT is like surgery in that it causes some damage that requires energy to repair, so some fatigue is to be expected. Finally, I tell them t...
What dose/fractionation would you use for a patient with unresectable, ER+/PR+/HER2 negative breast cancer who declines chemotherapy and progresses locally after receiving endocrine therapy with abemaciclib?
I think there are a few approaches to this. I would first discuss with my surgeon, what makes the patient unresectable. One consideration if borderline resectable is neoadjuvant RT, I use this study as a guide though sounds like the patient may refuse capecitabine (Woodward et al., PMID 28843370).If...
Should osimertinib be held prior to yttrium 90 liver directed therapy?
While not a common scenario and thus paucity of high level of incidence, I will, in principle, hold 1-2 days before the procedure and wait until a week post procedure ensuring LFTs are within acceptable range before restarting osimertinib.
Do you perform an MRI after SpaceOAR Vue placement if you already have a pre-procedural MRI and are not doing a FLAME style boost?
I do, yes. I also obtain MRI for planning when there is no hydrogel spacer (as did many before me when no one was using spacers).The apex and base are better demonstrated on MRI. This paper by McLaughlin et al., PMID 19515511 shows examples of common errors on CT-only contours.I do focal RT boost on...
Would you consider regional nodal irradiation for a patient who refused initial adjuvant breast RT who now presents with locally recurrent multifocal breast cancer s/p lumpectomy with positive margins and no nodal evaluation?
I would recommend margin re-excision with a sentinel node biopsy at that time prior to any radiation. If the SNB is negative, I would not recommend coverage of the regional nodes.
Does recent COVID-19 infection result in elevated PSA?
A study from Turkey showed that PSA can increase sometimes dramatically in men with BPH (not necessarily with prostate cancer) during active COVID infection, from an average of 1.5 pre-COVID to 4.3 during active infection. (Cinislioglu et al., PMID 34626600). One can imagine a similar phenomenon may...
How long do you wait after fiducial marker placement to simulate patients undergoing liver SBRT?
I give it 3 days - never noticed anything to make me want to wait longer.
What is the recommended length for ADT in the setting of N1 disease receiving definitive radiation?
In such cases, I typically recommend two years of ADT + abiraterone based on the results of the STAMPEDE high risk localized/N+ subgroup (Attard et al., PMID 34953525). At 6 years, the addition of abiraterone led to an absolute benefit of 13% in metastasis-free survival (82% vs. 69%; HR 0.53), and a...
What is the recommended radiation treatment volume for a patient with orbital DLBCL who achieved a CR to chemotherapy?
I suggest consulting the excellent guideline from the ILROG. There is a difference between Primary Intraocular Lymphoma and Orbital (Ocular Adnexal) Lymphoma. The guideline also describes which patients can be managed without irradiation of the entire orbit.