Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How does SUPREMO alter your recommendations for PMRT?
The recent SUPREMO trial provides data that might alter my prior posts on the topic of PMRT. The SUPREMO trial demonstrates that chest wall RT alone, in a relatively favorable subgroup of patients, is not helpful.Regarding T3N0, I previously wrote on MedNet: "When treating PMRT in the pT3N0 setting,...
How do you advise a patient with a history of HR+ breast cancer who would like to go on HRT for postmenopausal symptoms?
I would say systemic hormone replacement therapy is generally not recommended because of concerns about recurrence. I would assess the severity of symptoms and explore non-hormonal options. If her main concern is vaginal symptoms, low-dose vaginal estrogen may be an option depending on the severity ...
Based on the recent guidelines, should prostate SBRT dose be no higher than 3625 cGy in 5 fractions?
We have delivered prostate SBRT in high volume using 3,800 cGy/4 fx since 2006. The UCSF group has also used this schedule in a large number of patients for a similar time frame. For over a decade prior to that, the exact same dose regimen was used with HDR brachytherapy and published as "safe and e...
How do you sequence radiation and capecitabine in breast cancer patients receiving adjuvant capecitabine for residual disease after neoadjuvant chemotherapy?
According to personal communication with Dr. Masakazu Toi (June 13, 2017), the corresponding author of the CREATE-X NEJM publication, radiotherapy was administered prior to capecitabine in the majority of cases on this study. It is worth noting that in CALGB 49907, a randomized trial comparing capec...
Do you consider induction immunotherapy or chemoIO prior to chemoradiation for locally advanced PDL-1> 50% NSCLC if normal tissue constraints are not met?
If normal tissue constraints can't be met, or significantly higher chance of distant metastatic disease due to extensive local/regional disease, I would consider induction chemo/IO for patients with negative EGFR, ALK mutation and PD-1>1% before definitive chemo/RT in inoperable stage III NSCLC. Thi...
How do you manage early stage I uterine serous carcinoma?
The management of these patients remains controversial. The data are conflicting and treatment choices tend to be based more on impressions than solid data. Most clinicians advocate chemotherapy although randomized trials have not clearly shown benefit for this subset. For stage IA, we typically tre...
Would you offer a third course of palliative radiation after two courses of 8 Gy in 1 fx?
Hip pain can mean different things - is it the ilium, ischium, acetabulum, femur, or L-spine causing the pain?If it is the exact same bone as previously treated, a third fraction of 8 Gy can generally be safely given over the course of 4 years, especially if pain relief each time has lasted ~2 years...
Can we use a linear accelerator to sterilize PPE?
Per FAQ's posted by ASTRO: "At this time, ASTRO does not recommend the use of clinical linear accelerators to sterilize PPE. While ionizing radiation is used for sterilization of blood and food products, this is achieved using industrial irradiators that use gamma irradiation at doses rates far grea...
What is the best approach in a patient with a single brain metastasis in the setting of progressing systemic disease?
There is no single "best approach" for a single brain metastasis, even in the setting of progressing systemic disease. First, ask if it is obvious that a single lesion is a brain metastasis. The patient needs to be made aware that the diagnostic error rate can be as high as 15%. If unsure, then tiss...
Has the recent SBRT vs HDR monotherapy analysis changed your use of HDR monotherapy for intermediate-risk prostate cancer?
With excellent outcomes with SBRT in this group (PACE-B), the additional advantage of brachy is limited. The predominant use of HDR brachy is either as a boost for high-risk or as salvage after previous EBRT.