Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you counsel/advise patients when asked to compare ultrahypofractionated radiotherapy with the TULSA procedure?
I start by noting that the three NCCN-guideline recommended management plans for favorable-risk prostate cancer are radiotherapy (including SBRT), surgery, and active surveillance, and the latter two often require additional local therapy to render a patient cured within the next 5-10 years. In gene...
What is your preferred approach for the management of choroidal oligometastases?
We typically treat choroidal metastases with external beam radiotherapy. An argument could be made to treat with systemic therapy in the minimally symptomatic patient that has a high likelihood of response to systemic therapy (for example, ER+ breast cancer). Brachytherapy could be considered for a ...
How do you counsel cancer patients when they ask if they should avoid sugar?
“We don’t have evidence to support any specific diet that can either worsen or improve outcomes. I encourage a healthy, well-balanced diet with my top priority being you maintaining your weight during treatment.” Particularly for my head and neck patients, getting in sufficient calories is of the ut...
How will the results of NRG GU006 and the use of the PAM50 genomic classifier impact treatment for recurrent prostate cancer?
Top line results: The prostate cancer-adapted PAM50 gene expression biomarker was validated in the NRG GU006 randomized trial to predict the differential benefit of hormone therapy, specifically apalutamide monotherapy, for patients with recurrent prostate cancer after radical prostatectomy being tr...
Is there additional concern for late cardiac toxicity when using ultrahypofractionated breast radiation protocols, given that the BED to the heart is higher?
The BED to the heart isn't actually higher in this setting.Dr. @Dr. First Last explained this below, but I'll just explain it another way. Imagine that you place the block edge so that it is touching the heart (i.e., the heart is completely covered by the MLCs, and there is no margin between the MLC...
Do you omit PMRT for patients who would have been eligible for NSABP B-51, but are found to have significant pure LVSI only, without stromal carcinoma, after neoadjuvant chemotherapy?
I would treat it like a partial response and favor RT.
Would you offer partial breast irradiation for a patient who otherwise meets PBI guidelines but has a PTEN mutation?
I would say increased risk of new primary in residual breast tissue, like BRCA mutation, and for that reason would recommend whole breast over APBI.
Do you still recommend SBRT for oligometastatic and oligoprogressive breast cancer after the abstracts of the BR002 and CURB, respectively?
"Absence of evidence is not evidence of absence." The negative trials have put a damper on enthusiasm for these patients. This is interesting in light of past training and thinking where breast cancer patients with solitary or few metastases were thought to be emblematic of those that we could poten...
When is it necessary to boost the chest wall scar post-mastectomy?
Theres is no easy answer to this question, and utilization of scar boost varies across institutions based on preferences and interpretation of scant data. Notably, the original ASCO guideline on PMRT explicitly stated that there was insufficient data to say anything about using a scar boost (Recht, ...
What are your top takeaways in Medical Oncology from SABCS 2024?
I would give the following studies the top 3 in terms of impact: GS2-12:The PATINA study, that tested the use of palbociclib in patients who were on maintenance first-line therapy after induction therapy for metastatic HER2 and hormone receptor-positive breast cancer with taxane or vinorelbine plus ...