Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you approach rising PSA following radical prostatectomy and early salvage radiation therapy?
There are several factors that I will take into consideration, including the patient's overall health, the interval from treatment to relapse, the PSA doubling time (rather than a PSA threshold), whether or not they're castrate resistant and whether or not they now have overt metastatic disease. Pat...
When treating a patient with classic early stage diffuse large B-cell lymphoma (Stage I/II), when is it appropriate for patients to receive 3 versus 6 cycles of R-CHOP chemotherapy when the treatment is followed by ISRT?
The SWOG 8736 study included patients with stage I (bulky or non-bulky) and nonbulky stage II aggressive non-Hodgkin lymphomas (mostly DLBCL). Bulky was defined as a mediastinal mass >1/3 maximal chest diameter or any mass > 10 cm. Patients were randomized to 8 cycles of CHOP or 3 cycles of CHOP + R...
What would your approach be in a man currently on treatment for high-risk prostate cancer with ADT who does not have castrate levels of testosterone?
Yes, I would try alternative agents. If using Lupron, consider relugolix, degarelix, high-dose bicalutamide, or even adding an ARSI.
What fractionation would you offer to a young pre-menopausal woman with early stage ER+/HER2- breast cancer who received adjuvant chemotherapy and is highly interested in maximizing breast cosmesis?
40 Gy in 15 fractions with focus on dose homogeneity aiming for V105 < 5%.
Given the results of LU002 presented at ASCO 2024, are there situations and/or patient subgroups who still derive benefit from local consolidative therapy for oligometastatic NSCLC?
This is a tricky trial to interpret. They allowed a mixture of "stage I" primaries with oligomets and "stage III" locoregional disease with oligomets. The former got SBRT to the primary and the latter got 45 Gy/15 fx to primary and involved LN. There is a huge difference in the "ablativeness" of tho...
In a patient with prior RT to the prostate and SVs and newly diagnosed, locally advanced rectal cancer at 10-15 cm, would you offer preoperative chemoradiation?
"Locally advanced" rectal cancer was traditionally described as T3/4N0M0 or TxN+M0 cancer, but we have advanced much farther on the characterization of this now.We also know that the local control of patients undergoing resection for high rectal cancer (10-15 cm from the anal verge) is much better t...
Would you include the tract in your treatment field in a patient with squamous cell carcinoma of the anal canal presenting with an ano-cutaneous fistula?
I don't know that there is an evidence-informed answer, but I just had this in a patient recently. We had him get a diverting colostomy prior to starting CRT, then treated him with standard CRT with 5FU/MMC. I included the fistula tract in an intermediate dose, but with a margin on the boost to tumo...
How do you incorporate DCISionRT testing in the setting of close (<2 mm) or positive DCIS margins?
No matter how much Panera Bread they bring you, the answers are these: Positive margin? Surgical re-excision. <2 mm margin? Surgical re-excision. Why? Because the SSO guidelines say so. That's why. "But she doesn't want surgical re-excision for the positive margin." Ok. Then you recommend radiation...
Would you consider adding gabapentin off label for use in the treatment of glioblastoma at this time?
As an author on the paper, let me emphasize the findings and speculate on the implications. Recently, a number of laboratories have unraveled stunning preclinical and mechanistic findings demonstrating the ability of a subset of malignant glioma cells to usurp neuronal circuitry to promote tumor gro...
How do you counsel glioblastoma multiforme patients on which types of clinical trials to pursue?
This is a great question! In general, I think that a clinical trial gives someone access to promising therapies (and of course glioblastoma is an aggressive tumor for which we have no cure), but enrolling in one may not feel like the right decision for all patients (for a variety of reasons). I thin...