Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Without radiographic evidence for metastatic disease, is there a PSA value above which high risk localized prostate cancer should not be treated definitively?
The SPCG-7/SFUO-3 randomized trial randomized 875 patients to endocrine only therapy vs. endocrine therapy plus radiation therapy. 20% of the patients had a PSA > 30. The addition of radiation showed an overall survival benefit at 10 years (60.6% vs 70.4%), a prostate cancer specific survival benefi...
How would you treat Classic Hodgkin's lymphoma when the nodal sites are non-contiguous?
The question has insufficient information. I'm going to assume that the patient had chemotherapy with a PET/CT complete response. Based on that assumption, then the general principles are that if the sites of involvement are > 5 cm, that you should have multiple treatment fields, but if they are les...
What are the current thoughts for ADT and prostate SBRT for low-Intermediate risk patients?
Although I have no strong bias regarding ADT for low-intermediate-risk prostate cancer patients receiving SBRT, the growing volume of retrospective data in the same setting with HDR brachytherapy suggests that ADT is not needed. With HDR (either monotherapy or boost), I do not use ADT for intermedia...
Is liver radiotherapy contraindicated in patients with Child-Pugh C liver function?
I think one should be very cautious with regards to radiation for this group, whether palliative or definitive. The CPC patient has a very poor prognosis with a 2 year expected survival of only 30%. We have learned that patients with CPB liver disease, especially those with scores of 8 and above, ar...
Given the recent pooled analysis of STARS and ROSEL trials, can we say SBRT for early stage NSCLC is equivalent to lobectomy based on level 1 evidence?
We still do not have Level I evidence to answer such a question. Both STARS and ROSEL closed prematurely. If we read @Dr. First Last's Lancet Oncology paper more carefully, unlike others who have interpreted it as radiation oncologists running amock to claim SBRT is now equivalent to surgery, the di...
Should post-op RT be delayed for children < 3yo after a GTR resection for a posterior fossa or supratentorial ependymoma?
Standard of care for a GTR posterior fossa ependymoma of any histologic grade is immediate adjuvant radiotherapy. If a STR is encountered, chemotherapy may be considered to try and facilitate a second look surgery. The current protocol allows patients with supratentorial ependymomas that have receiv...
What is the value and potential morbidity of second look surgery in patients with sub-totally resected ependymoma?
Since gross resection of ependymoma is associated with improved prognosis, chemotherapy is frequently used to render sub-totally resected ependymoma potentially resected totally during second look surgery (thereby improving prognosis). One of the main reasons that the tumor in the posterior fossa is...
Do you consider 1.8Gy and 2Gy fraction sizes completely equivalent when performing whole breast radiation therapy?
Although they probably are, I tend to use 1.8 Gy for conventional treatment. Given how well women do with 2.66 Gy with hypofractionated regimen, it seems logical that a 2 Gy fractionation should be just as well tolerated.
For early stage NSCLC to be treated with SBRT, is there any difference in the technology being used such as robotic v. linac based VMAT?
In my opinion, as long as the SBRT team can follow the principles and safety measures, there shouldn't be any difference in treatment outcomes and toxicities among different treatment devices for early stage NSCLC. In other words, the expertise of the team is much more important than the treatment d...
Are there certain clinical scenarios that make you favor a lower whole breast total dose but higher lumpectomy cavity boost?
In patients with large breast size where dose homogeneity is not optimal we do 45 Gy in 25 fraction to breast and 16 gy boost for total dose of 60 Gy to the surgical bed site.