Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you treat a patient with ER/PR positive breast cancer with a single site of bone metastasis?
I would still treat with hormone therapy and a CDK 4/6 inhibitor. Not clear if the question refers to denovo disease or not. I generally do not treat asymptomatic bone mets with radiation, as there are late effects in patients who have a relatively long life expectancy and no data to suggest that ra...
In what circumstances would you consider use of IDH inhibitors in high-grade astrocytomas?
Please forgive me for the length and directness of my response, but I believe it is important to first go over the INDIGO trial and explain why, in my opinion, it was a highly questionable study, with multiple significant methodological flaws and dubious evidence of Vorasidenib's efficacy.INDIGO tri...
How do you manage a spinal intramedullary metastasis following resection?
Complete surgical removal (gross total resection) of an intramedullary metastasis may not be possible without damaging normal spinal cord tissue, especially for more infiltrative tumors. Postoperative radiation therapy is therefore used to treat any residual tumor cells that were left behind to pres...
How can you manage a patient with bilateral PCNs who requires Pluvicto administration?
We've treated several of these folks. In general, we ask the patients to ensure they are emptying the bags frequently for the first three days to minimize the volume of urine next to the skin. There have been reports of radiation dermatitis from Foley/PCN bags that are left in the same spot against ...
Would you offer neoadjuvant chemotherapy prior to trimodality therapy in a fit patient who refuses surgery for muscle-invasive bladder cancer?
Unfortunately, this is a question without a clear answer at this time. Trimodality therapy, consisting of maximal TURBT, chemotherapy, and radiation, appears to have equivalent outcomes and has NCCN Category 1 recommendations for patients with MIBC. We do not routinely do neoadjuvant chemotherapy fo...
How do you treat a patient with early-stage breast cancer s/p lumpectomy and oncoplastic reconstruction with a positive margin, when re-excision is not feasible?
It depends on the level of oncoplastic surgery done. If level 1, we can identify the surgical site and can boost after whole-breast RT of 26 in 5 or 40 in 15. If level 2 or 3, then just increase the whole breast dose to 42.5 in 16, as we can’t identify the boost area.Han et al., PMID 40024440
Are you offering Lutathera for multiple recurrent meningiomas?
Lutathera is currently only FDA-approved for treating somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumors (GEP-NETs). However, research is ongoing to explore its potential use for meningiomas, as many meningiomas express somatostatin receptors, which could make it a promising...
What dose constraints do you use for 60 Gy in 15-20 fraction lung treatments that are adjacent to the hilum?
The LUSTRE trial, which is a Canadian RCT comparing SABR (60/8, 48/4) vs. 60/15 provides some max point constraints to address this for 15#. Swaminath, Clin Lung Cancer. 2017 Mar;18(2):250-254. Spinal Canal 36 GyEsophagus 48 GyBrachial Plexus 50 GyHeart 66 GyGreat Vessels 66 GyTrachea/PBT 66 GySkin ...
What dose constraints do you use for the left anterior descending artery (LAD) for breast radiation?
We published in the Red Journal in 2022 a single-institution analysis of LAD/heart dosimetry and association with cardiac events in 375 patients with a history of left-sided breast or chest wall irradiation: Zureick et al., PMID 35483540LAD Dmean EQD2 of 2.8 Gy and LAD Dmax EQD2 of 6.7 Gy were found...
What is your experience with Pylarify vs. Posluma PSMA PET for prostate cancer and is one preferred over the other?
There is no definitive evidence at this time that one of these imaging agents is clearly superior to the other because there are no comparative data in the same patient group.For Posluma, the potential benefit over Pylarify would be lower bladder excretion allowing for better visualization of the pe...