Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you consider SBRT for an inoperable T1-T2 N0 SCLC?
The concept of using SBRT in the setting of inoperable early-stage node negative small cell lung cancer (SCLC) is interesting and replicates the concept of SBRT as a surgical surrogate. In other words, SBRT is used to manage the primary lesion, as with early-stage non-small cell lung cancer (NSCLC)....
What dose/fractionation regimen do you use for the moderately accelerated, hypofractionated treatment of localized prostate cancer?
I use 70 Gy in 28 fractions. Rationale in brief below-Tested and proven to be non-inferior in RTOG 0415Less valid but important; we have been using this regimen at the Durham VA for nearly a decade.It is hard to be dogmatic; several regimens have been described in the literature but only two have be...
What RT fields should be used to treat a triple negative breast cancer with biopsy positive lymph nodes and a pCR to neoadjuvant chemotherapy?
Practice patterns after NAC remain highly variable with no clear accepted standard particularly when there is a complete pathologic response (See Haffty et al. Red Journal 2016). While B51 may answer this question the jury will be out for a long time. Clearly enrollment in B51 is the ideal approach....
Should adjuvant CRT be considered in gastric cancer patients who received pre-op chemo based on the recent results of the CRITICS trial?
There are many nuances here, but CRITICS suggests that there is little if any benefit to the routine use of postoperative chemoRT, in addition to pre- and post-op chemo, in resected gastric cancer patients who undergo a D2 dissection. The only scenario where I really consider postop CRT to be strong...
What dose should be used for a G3 retroperitoneal sarcoma with R1 resection?
Dose should be individualized based on location as one size would not fit all. Rcenet NCDB analysis in lancet oncology appears to show survival benefit with RT for RP sarcoma. If not in close proximity to bowel and dose to duodenum and kidneys can be kept to safe limit, then I would consider a dose ...
Is there a role for adjuvant radiation in phyllodes tumors of the breast?
The role of adjuvant RT after BCT for phyllodes is not well defined, with wide variation in local recurrence reported in literature and practice is not uniform. The risk of local recurrence appears to be a function of the type of phyllodes (malignant vs. benign), size, and margin status (which to so...
Are there any situations in which you would offer postoperative RT for node positive prostate cancer?
The textbook answer, based on Messing NEJM, is ADT for node+ patients post-prostatectomy, but this is certainly a moving target.As node+ patients were excluded from all adjuvant (EORTC, German, and SWOG) and salvage (RAVES, RTOG 0534) randomized trials, there is currently no level I evidence for XRT...
How would you follow patients with differentiated thyroid cancer that no longer picks up iodine after thyroidectomy and RAI, and have thyroglobulin antibodies?
The presence of antibodies makes measuring the thyroglobulin level essentailly inaccurate. PET imaging may have a role though clear data on its utlity is limited (and it's expensive). Physical exams and Ultrasonography is the best way of monitoring the disease state from a surveillance point. For sy...
When should post-op RT be offered in patients with recurrent papillary thyroid carcinoma that no longer takes up iodine?
Non-iodine avid, otherwise well-differentiated thyroid cancers have traditionally been considered a reasonable target for external beam radiotherapy. In my practice, XRT is considered once the disease is no longer considered amenable to non-morbid surgery. However given the rise of endocrinologic on...
Given the results of the GETUG 14 randomized trial presented at ASCO 2016, should all men with intermediate-risk prostate cancer receiving dose-escalated radiotherapy receive concurrent ADT?
Neither the GETUG 14 or EORTC 22991 study just published in JCO are mature enough yet to fully answer the question based on endpoints of death from PC and/or overall survival.The third study looking at this is RTOG 0815 which also is not mature yet.It is likely that men with favorable int risk can b...