Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What dose constraints do you use for RCC/Kidney SBRT?
As is often the case, there is no single answer to this question, and the ALARA principle should always be kept in mind. A good starting place to determine your OAR constraints for a given case is to consider the clinical context. Ultimately, in deciding on allowable OAR constraints, one has to cons...
How does neoadjuvant chemo-immunotherapy impact your decision on hypofractionation/dose fractionation for locally advanced NSCLC, now getting RT alone?
If a patient has already received 3-4 months of a platinum-doublet chemotherapy during the chemo-immunotherapy phase, then it's always my preference to omit further chemotherapy and recommend RT alone. The rationale for this recommendation is that we don't administer additional chemotherapy to patie...
When treating prostate cancer with moderate hypo-fractionation, what urethral dose constraints do you consider when boosting the dominate intraprostatic lesion?
As Dr. @Dr. First Last mentions, the FLAME protocol did not utilize a urethral constraint; however, in a post hoc analysis, they did suggest a constraint of D0.01cc ≤ 80 Gy in 35 fractions (Groen et al., PMID 34968470). It is hard to know how to apply this given the uncertainty regarding the appropr...
How are you integrating Prostox into your practice for prostate patients deciding between SBRT and hypofractionation?
Curious how people are using this test?
How do you manage rectal wall infiltration during a rectal spacer procedure?
At ASTRO 2023, PACE-B reported RTOG grade 2+ GI toxicity was exceedingly low at only 1/348 for 78 Gy/39 fx or 62 Gy/20 fx and only 1/363 for 36.25/5 fx. Anyone know what % of patients in PACE-B had SpaceOAR or similar products? This raises the question of whether SpaceOAR or similar products are nee...
Is there any threshold regarding extraprostatic extension to contraindicate a rectal spacer?
This is an important question, and as far as I know there are no data to guide a response. I personally believe that EPE (within reason) is not a contraindication to hydrogel. One would expect the extension, capsule and prostate to lift in unison, depending on where the extension is. The NCCN guidel...
How would you treat an early-stage ER/PR+ Her-2 negative breast cancer s/p lumpectomy in an elderly patient who had sentinel node biopsy omission?
I consider these patients as being managed appropriately surgically based on CALGB and current guidelines. As such, I routinely offer these patients APBI.Unless there are other features, I do not think these patients need WBRT just because they didn't have a SLN. If they are eligible for omission of...
When selecting mCRPC patients for Pluvicto, which baseline variables do you find most useful or predictive of potential hematologic toxicity?
One important consideration in the recommendation of Lu-177-PSMA radiopharmaceutical therapy (RPT) is an assessment of a patient’s marrow reserve, as hematologic toxicity is one of the most common clinically relevant toxicities after such treatment. Important clinical features to help assess the lik...
Would you consider utilizing pembrolizumab/enfortumab as a bladder preservation approach in patients with MIBC?
Yes, I think that this is a viable approach. Data from perioperative trials, including KN-905 and EV-304, suggest very high rates of pathologic complete responses in almost two-thirds of all patients at the time of radical cystectomy. Many of these patients may not need radical cystectomy for an opt...
How would you manage a high grade acinic cell carcinoma of the parotid with isolated recurrence in the ipsilateral neck s/p salvage resection?
For this patient with a neck recurrence and (presumably) no evidence of primary site recurrence who had been treated with RT previously to the parotid bed, I would treat ipsilateral neck levels IB, II, III, IV, and V. While IB coverage may be controversial, if the recurrence was in level II, I would...