Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage a locally advanced prostate cancer with positive pelvic nodes, incidentally found at the time of radical cystectomy for bladder cancer?
A growing body of retrospective data suggests a benefit to the addition of pelvic radiation in addition to ADT in men with node-positive prostate cancer. The decision to treat, in this case, has to be balanced by the competing risks related to the bladder cancer. If the patient's prognosis from the ...
How do you balance short-course ADT in unfavorable intermediate risk prostate cancer patients with cardiac comorbidities?
One paper that addresses the topic was published in the Red Journal in 2016 (Rose et al., PMID 27788950). This retrospective analysis attempted to answer the question of which patients would derive disease-specific mortality benefit from the addition of ADT. Patients included in this analysis were f...
When would you offer post-operative therapy to a resected non-melanomatous skin cancer with a solitary positive node?
I treat them all. If they are fit enough for surgery, their prognosis is good enough to treat.
When are increased flank doses beneficial in Stage III Wilms tumor?
The current standard of care in North America for radiotherapy dose in the treatment of Wilms tumor (WT) has been established by the National Wilms Tumor Study (NWTS)-3. This study randomized Stage III favorable histology patients to 1000 cGy vs. 2000 cGy as well as 2 drugs (actinomycin D and vincri...
How would you manage prostate cancer in a patient who received prior chemoradiation followed by LAR for rectal cancer?
In this situation, I would recommend brachytherapy, assuming the patient has sufficient rectum to visualize the whole prostate gland (a pre-procedure volume study or in-office transrectal ultrasound will give you the answer). Either LDR or HDR, as both have data to support use in prior pelvic or pro...
What is your approach to elective radiation of the neck with primary cutaneous squamous cell carcinoma?
The ASTRO Clinical Practice Guidelines for treatment of BCC and cSCC (Likhacheva et al., PMID 31831330) provides specific guidelines for elective treatment of draining lymphatics. A thorough review of the literature revealed that the most important predictive factor for occult lymphatic spread is tu...
Do you routinely recommend proton therapy for whole ventricular radiation for intracranial germinoma after chemotherapy?
The pattern of failure data from SIOP GCT '96 (Calaminus et al., PMID 23460321) and the SFOP-90 experience (Alapetite et al., PMID 20716594) in which patients with localized CNS germinoma were treated with induction chemotherapy followed by focal radiotherapy was predominantly intraventricular. Ther...
Would you utilize single fraction palliative radiation therapy for a large bone metastasis?
The issue of field size was addressed in an early RTOG study (RTOG 78-10) where they looked at half-body RT. It was extremely effective with 73% partial or complete response and fast-acting, with 50% of patients experiencing relief within 48 hours. (Salazar et al., PMID 2423225). Patients could be r...
What is your local therapy paradigm for unresectable pelvic EWS cases?
Unresectable pelvic Ewing sarcoma tumors are treated with definitive radiation therapy. The Children's Oncology Group local failure analysis of patients treated on INT-0091, INT-0154, and AEWS0031 demonstrated pelvic tumors treated with radiation therapy alone had a local failure incidence of 22.4% ...
Do you incorporate immunotherapy in your multi-modality treatment after chemoradiation for patients with potentially resectable stage III superior sulcus NSCLC?
No. Durvalumab therapy in NSCLC is currently limited to patients with unresectable disease. PACIFIC clearly demonstrated an enduring survival benefit of consolidative Durvalumab therapy after combined chemo-radiation therapy in patients who did not undergo surgical resection. The NeoCOAST trial is c...