Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What are the current recommendations for androgen blockade for patients undergoing salvage radiation after prostatectomy with PSAs between 0.6 and 1.5?
Just be a little careful here. Although Dr. Spratt did an amazing analysis and thorough presentation of the subgroups, one shouldn't look at PSA <=0.6 as a "cutoff". As Dr. Spratt pointed out in his presentation, the population on RTOG 9601 was mixed in terms of prognostic features.. Would you reall...
How often do women develop HPV associated oropharyngeal cancers?
HPV associated Oropharyngeal SCC is much more common in Men than Women, nearly 3-4 times higher. One possible explanation is higher prevalance of HPV virus in female genitalia as compared to men, however, biological differences in viral clearance may also be a factor. Although, the incidence of HPV ...
In the setting of prior salvage radiation therapy for rising PSA post prostatectomy, can there be any role of additional radiation therapy for isolated local recurrence in the bladder neck/prostate bed?
I have not run into this scenario. If it is visible on imaging (ultrasound +/- CT or MRI) I would explore the possibility of HDR, 13.5 Gy x 2. Careful consideration would need to be given to the location of the recurrence and anatomy. Technically it may be challenging due to scar tissue and the limi...
Would you omit a lumpectomy boost in a patient with a single positive sentinel lymph node, with a primary tumor that is otherwise favorable?
For luminal A breast cancer like her benefit of boost is very limitedm as IBTR is 1-3% and sentinel nodal status would not influence decision not to boost.
In patients with rectal cancer receiving neoadjuvant chemoradiation, how does possible seminal vesicle involvement on MRI affect the contours of your target?
I would include the entire seminal vesicle with a margin and add the external iliac nodal region in prophylactic volume.
How do you approach early stage, mixed histology lung cancer (SCLC and NSCLC components) in patients with good performance status?
Certainly the simplest approach for an early stage mixed SCLC/NSCLC would be upfront surgical resection and node dissection (provided that good performance status implies medical operability), and then pathologically if a true small cell component is confirmed (or if the patient is found to be node ...
Would you hold off on whole brain radiotherapy for a patient with metastatic NSCLC and multiple asymptomatic brain metastases and will be starting immunotherapy?
This is a very controversial area right now (as are most MedNet queries!). Given the data available and the opinion pieces by thought leaders right now on immunotherapy results in melanoma brain metastases, it would be very reasonable to hold off on WBRT for patients with asymptomatic melanoma brain...
How do you manage pelvic pain and hematuria due to recurrent high grade transitional cell bladder cancer who had received 70 Gy to bladder and is not a chemotherapy or surgical candidate?
It depends whether these symptoms are caused by radiation, recurrence, or both. One might not be able to distinguish. For hematuria I think a cystoscopy and focal fulguration if that is available to the patient, or else consider hyperbaric oxygen therapy, which may also improve pain (I don’t think h...
Would you skip adjuvant RT in post prostatectomy patients?
I suspect that once the paper is published and we get a chance to review the data that we may begin to hold off on routine use of adjuvant RT for prostate cancer patients after radical prostatectomy with higher risk features. That said, it should be noted that the study did randomize to early salvag...
How would you manage a patient who received neoadjuvant CRT per the CROSS trial for esophageal cancer, but refuses surgery after imaging shows a good radiographic response?
That's a great question. It is not evidence based, but with carbo/taxol (CROSS approach), I sometimes will go to 50.4 in case this very situation occurs. It's very well tolerated with conformal approach (the study treated with 41.4 Gy with AP-PA fields). If it has already happened, and too much ti...