Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you offer adjuvant radiotherapy for completely resected breast fibromatosis after lumpectomy?
I would not, following the principle of managing fibromatosis at other sites.
Are there studies looking at Ra-223 and SBRT for oligometastatic disease in the setting of mCRPC?
Yes, quite a few including one from UCLA- NCT05496959
Would you manage a subtotally resected pilocytic astrocytoma with deleted CDKN2A differently than one with intact CDKN2A?
Among brain tumors, CDKN2A loss has the greatest clinical implications in histologically low and intermediate grade gliomas. In IDH-mutant astrocytomas, the presence of homozygous deletion of CDKN2A is associated with poor outcome. Usually, pilocytic astrocytomas (grade 1) have a very good prognosis...
Would you offer ultrahypofractionated 5 fraction breast radiation to a patient with lupus?
Favor partial breast over whole breast if feasible.APBI or IMPORT LOW volume and FAST-Forward dose of 26 in 5.
How does the extent of DCIS influence eligibility for APBI for invasive breast cancer?
EIC as described above is fine for APBI as long as other criteria are suitable.
Is there a dose to the lens that would be a contraindication for future cataract surgery?
I am not aware of any such dose limitation. Development of cataracts is not an acute process and consultation with an ophthalmologist would be the most appropriate course of action to determine when the surgery can be performed.
Would you treat the prostate in a patient with widely metastatic disease who has CR to all metastatic sites after systemic therapy or ADT?
This is an interesting hypothesis, but requires further study before offering. The trials that define a benefit to prostate RT in the metastatic setting (HORRAD, STAMPEDE, and now PEACE-1) did not use response-adapted selection criteria. Therefore, we cannot say that radiation to the prostate in an ...
For a patient with a lung tumor that is radiographically consistent with early-stage NSCLC but pathology with characteristics overlapping with upper GI origin, what additional diagnostic procedures would you consider before treating?
In the absence of imaging findings in a patient with a risk profile consistent with early-stage NSCLC, I would probably just move forward with definitive management as NSCLC with either surgical resection or SBRT as appropriate. The only other thing I would consider is to make sure they are up to da...
Would you offer RNI for young patient with cT3N0 triple negative breast cancer that had progression of disease during neoadjuvant chemotherapy, followed by mastectomy and sentinel node biopsy?
Yes, without hesitation. The primary randomized data suggesting an improvement in overall survival (OS) with PMRT in the T3N0 setting included RNI (e.g. Overgaard et al., PMID 9395428). There is also a study of +/- PMRT (including regional nodes) in T3 patients (about 40% of which were T3N0), that a...
With the current cisplatin and carboplatin shortages, for HPV+ H&N patients with indications for concurrent chemoRT, which agent do you recommend next?
The question of 2nd line therapy is difficult due to the dearth of data. This leaves essentially 3 choices - immunotherapy, cetuximab, or other cytotoxic agents.Regarding immunotherapy, recent trials for concurrent IO have been mixed, tending to compare IO vs Cetux. The main take-home though, is the...