Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you give abiraterone in the post-prostatectomy setting to patients with positive nodes detected at surgery?
This clinical scenario of N1 but resected disease post-RP represents an area where there is not sufficient evidence to recommend abiraterone or any potent AR inhibitor. While there is evidence to support ADT in this adjuvant setting for N1 resected patients based on the older Messing ECOG trial, sim...
Does your recommendation for ADT change in an elderly patient with dementia and high risk prostate cancer?
Thank you for this question. There have been publications that have shown the association of ADT and cognitive decline. Probably one of the most robust studies was published in 2017 (Nead et al., PMID 27737437) in which the effect of ADT on dementia risk was assessed using propensity score-matched m...
How do you measure the skin dose when you are concerned about dosing to the skin?
We use diode.
Is APBI appropriate for patients with rare tumor histology (mucinous, medullary, or tubular) if they meet all other suitability criteria?
If phenotype right then it is tubular and mutinous are ER positive low grade tumor and are good candidates for APBI.
In what scenarios would you include the ventricles in your CTV for treatment of high grade gliomas?
I would not cover the ventricles prophylactically in any scenario. If you are concerned for involvement of the ventricles, then you have to think there's a high chance of CSF spread. In that case, you might want to consider whole brain RT.
How does avascular necrosis of the femoral head affect definitive radiation to the prostate?
I asked the question and have no long-term follow-up to draw on to answer it. For what it is worth, I will summarize below what I learned from discussion with one experienced orthopedic surgeon, plus some reading. If others have insight/comments/opinions, please share! AVN is irreversible. Risk fac...
Is there a reliable way to distinguish a metastasis from a secondary primary tumor if the histology is the same?
This issue may arise when a single lung lesion is found in a previously treated HNC, where distinguishing between a small secondary lung sqcca vs metastatic HNC have significant implications. A comparison of typical molecular characteristics in the primary and the secondary is a possible way. For ex...
Why is accelerated hyperfractionated RT still being performed in NRG trials such as HN005?
To go back a little bit in history, RTOG 1016 was designed prior to the results of RTOG 0129 were available. In the Bonner trial, most patients were treated with accelerated fractionation + cetuximab, and seemed to have better outcomes than those with conventional fractionation. Therefore, in the ab...
How do you deliver appropriate bilateral post-mastectomy radiation therapy for a young woman with a bilateral clinically node-positive lobular breast cancer with a pacemaker in place?
One has to prioritize and plan based on absolute benefit and would skip RNI on the side patient has pacemaker.
If colostomy is indicated prior to Nigro for locally advanced anal SCC, would you wait to simulate after this procedure or do you feel pelvic anatomy will not be distorted?
No reason to wait.