Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What small bowel dose constraints do you utilize when treating resected pancreatic cancer?
Questioning the normal tissue tolerance in the setting of a resected pancreatic cancer raises a number of issues. To answer the question of which of the listed dose constraints I use, the answer is neither. There has been a general trend in the field to use less conventional radiation therapy postop...
What duration of ADT do you recommend for a patient with otherwise favorable intermediate risk features but a mpMRI showing gross extracapsular extension?
All of the responses so far are reasonable to me. I am assuming the patient is Gleason 3+4 with PSA <10 ng/mL. I am wary of applying a new technology to categorize patients to older trials (i.e., T3 on mpMRI and assuming that is the same as clinical T3 prior to MRI). That said, I can't call a patien...
Do you alter your management of ADT in a patient with high-risk prostate cancer who is a transwoman receiving estradiol hormone therapy?
We published a case report several years regarding a transwoman who developed prostate cancer who had been on estradiol therapy in JAMA. She presented with a PSA of over 100. She continued on her estradiol therapy. We did not use LHRH since she had a bilateral orchiectomy for her transition. She was...
In what clinical scenarios would you cover the optic nerves when treating with whole brain radiotherapy?
In general, for brain metastases (assuming not a candidate for hippocampal avoidance) standard whole brain radiotherapy fields would cover part of the optic nerves. If whole brain is for primary CNS lymphoma, I would cover the orbits which would encompass the entire optic nerves. If whole brain RT i...
Is it safe for a patient to breastfeed during their course of EBRT?
Not aware of any concerns. In our pregnancy-associated breast cancer patients, I encourage women to breastfeed on the side I am not treating as long as med onc has cleared them. We work with pediatricians to ensure that the infant is reaching normal weight/growth milestones, but may need to suppleme...
Would you consider salvage radiation in a recurrent prostate cancer with a positive pelvic node and high inguinal node on PET/Axumin, but negative inguinal biopsy?
I would treat this patient as having oligometastatic disease to the nodes, similar to the more common scenario of finding 1-3 para-aortic nodes beyond a typical pelvic XRT field.Assuming no prior radiation to these sites, I would try a VMAT plan as long as skin constraints are met for the inguinal s...
Should I wear gloves during a routine physical exam on an asymptomatic patient with no risk factors for COVID-19?
As per FAQ’s posted by ASTRO: There is no reason to do so at this time. Be vigilant re: hand hygiene and wiping down any equipment that touches the patient (stethoscope, etc.). Additionally, any equipment that touches mucosa/secretions of the patient must be sterilized (rhinolaryngoscope, etc.). For...
Would you give abiraterone in the post-prostatectomy setting to patients with positive nodes detected at surgery?
This clinical scenario of N1 but resected disease post-RP represents an area where there is not sufficient evidence to recommend abiraterone or any potent AR inhibitor. While there is evidence to support ADT in this adjuvant setting for N1 resected patients based on the older Messing ECOG trial, sim...
Does your recommendation for ADT change in an elderly patient with dementia and high risk prostate cancer?
Thank you for this question. There have been publications that have shown the association of ADT and cognitive decline. Probably one of the most robust studies was published in 2017 (Nead et al., PMID 27737437) in which the effect of ADT on dementia risk was assessed using propensity score-matched m...
How do you measure the skin dose when you are concerned about dosing to the skin?
We use diode.