Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Which patients with mCRPC on ADT + advanced anti-AR do you treat with bisphosphonates or denosumab?
Men with bone-metastatic CRPC face a relatively high rate of fractures due to bone loss as a result of potent AR inhibition and ongoing ADT but also due to lytic and sclerotic bone metastases which create focal weakening of the bone matrix despite the pathologic bone formation. The fracture rate was...
Would you consider orbit sparing treatment for a lacrimal gland carcinoma?
Yes with protons.
Would you treat pelvic lymph nodes in your salvage prostate patient after RP without adverse features due to a limited/no pelvic lymph node sampling?
No, not based on lack of extended PLND, alone.RADICALS left lymph node coverage to physician discretion, and only 3% of salvage patients received pelvic lymph node irradiation. 44% of the patients on RADICALS had no lymph node dissection. Strongest evidence in favor is SPPORT, with biochemical contr...
When contouring the prostate bed for salvage XRT, do you include the mesorectal fat anterior to the rectum or just the mesorectal fat at or below the levator ani?
The classic 2010 RTOG consensus statement separates the posterior border by the pubic symphysis. Per this statement, inferior to the symphysis, the posterior border should extend to the rectal wall, whereas superior to the symphysis, the posterior border should extend to the mesorectum.I think in pr...
Do you recommend SBRT for an unresectable/unembolizable >10cm chest wall AVM with a diffuse nidus?
I would not recommend SBRT for this patient. Not sure if SBRT is indicated for any chest wall AVM. I think you could extrapolate from CNS and assume there could be some efficacy but there isn’t any good data that I’m aware of that SRS would help in this scenario. Moreover based on CNS AVMs, fraction...
Do you offer chemoradiation for de novo oligometastatic esophageal cancer after chemotherapy with no progression?
It is unclear if this is useful especially if asymptomatic from the primary/metastatic sites. The question is being assessed by ECOG/ACRIN in an ongoing randomized trial. The schema may be helpful. https://clinicaltrials.gov/ct2/show/NCT04248452
How do you treat localized prostate cancer with neuroendocrine differentiation?
Most hybrid or pure NEPC tumors lack PSMA expression as only 1/3 of metastatic NEPC tumors are PSMA PET+ and expression is typically very heterogeneous. For this reason, an FDG PET/CT would likely be a better staging test for this aggressive variant of prostate cancer. If this is also N0M0, RP is my...
Is prior prostate SBRT a contraindication to hemorrhoidal banding?
I would agree that there isn't a basis for a blanket denial of doing banding or other anorectal procedures to address QoL issues after prior prostate RT. There is, of course, a significant literature for argon laser, cautery, formalin, etc for radiation proctitis, and so if mucosal interventions are...
Would you consider short course radiation therapy for rectal cancer following APR?
No.
What is the rationale for 6 hours between EBRT and HDR fractions for BID treatment?
Based on half-life of repair of about 1.5 hours for most normal tissue (spinal cord is one of the exceptions). So 6 hours will be 90% repair with 4 half-life intervals.