Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you offer APBI in patients with a high Oncotype who are otherwise considered “suitable” per ASTRO guidelines?
I would be reluctant based on limited data showing high oncotype predicting for increased risk of local relapse even after RT. I would favor treating with whole breast plus a boost.
Would you extrapolate data from PACIFIC trial for unresectable disease to consider consolidation therapy with durvalumab for Stage III NSCLC with single-station N2 disease amenable to lobectomy?
I agree with both answers above. The question about adding durvalumab after chemo-RT and lobectomy continues to come up. I would not extrapolate the data from PACIFIC to this situation. First, its important to point out that its not indicated in this situation - the approval for durvalumab in the US...
How do you approach definitive radiation for prostate cancer in a patient with perineal urethrostomy?
Long Answer: I probably treat about 2 patients a year with perineal urethrostomy, usually due to recurrent penile cancer post penectomy. Keep in mind that when we treat prostate cancer, the penile urethra routinely receives ~78Gy EQD2 and with brachytherapy even higher biologically equivalent doses,...
How do you sequence follow up mammograms in patients undergoing breast cancer treatment?
In the followup of patients treated with breast conservation therapy, continuation of yearly mammograms is standard practice, even if the cancer in question was not seen mammographically. It would be quite unusual to be undergoing RT when the yearly mammogram was due, since even with the diagnosis o...
What are your indications for radiotherapy in children with pleomorphic xanthoastrocytoma?
Pleomorphic Xanthoastrocytoma is unique among other pediatric low grade gliomas in that it there is a high frequency of targetable alterations including BRAF V600E alterations and that there appears to be an increased risk of transformation relative to other pediatric low grade glioma histologies (P...
What criteria do you use when considering treating the pelvic nodes in a salvage prostatectomy case?
Perhaps I am biased because I have conducted research in this area, but I believe this is one of the more intriguing questions in our field. Particularly, given how many men are referred for post-prostatectomy salvage radiotherapy for a rising PSA. I had enthusiastically enrolled patients onto the R...
What is the best treatment approach for locally advanced (T3+ and/or N+) rectal cancer status post low anterior resection in a patient who has a remote history of seed implant for low risk prostate cancer?
These treatment decisions are best discussed within a multidisciplinary group. If the tumor is located on the anterior rectal wall and the prior high dose from the implant cannot be spared, there is a risk of rectal bleeding with re-irradiation if surgery is not performed and urinary fistula regardl...
How would you manage recurrent laryngeal cancer after previous larynx xrt if surgical salvage not an option?
Re-RT for recurrent laryngeal cancer when surgery is not an option was first proposed by CC Wang (IJROBP 1993;26:783-5). He reported reasonable local control rates and stated, at the conclusion of “Radiation Therapy Results†in his paper, that “significant radiation sequelae… were not encoun...
Is MRI necessary to distinguish prostate from rectal spacer (SpaceOar) when planning for definitive prostate radiation therapy?
Important question given the increasing popularity of the spacer gel! T2-weighted MR imaging is by far the best way to distinguish prostatic tissue from the hydrogel spacer. It's also a critical tool to assess accurate and high-quality placement of the spacer gel, namely to determine that is...
How do results from NSABP B-39 influence your practice for APBI compared to WBI in early stage breast cancer?
With respect to clinical outcomes, the results of B-39 confirm what the data previously available demonstrated. APBI is an appropriate option for appropriately selected patients. A less than 5% recurrence at 10 years is excellent and paired with the updated RAPID results provide confidence that part...