Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Does a rare histology prostate cancer, such as ductal or mucinous, change your typical management recommendations?
Intraductal cancers are often associated with Grade 4 prostate cancer and getting a mpMRI and performing a fusion TRUS/mpMRI bx of any PiRads 3, 4 or 5 cancer to r/o Grade 4 would be of value to recommend treatment as opposed to active surveillance in an otherwise Gleason score 6 PC. If Grade 4 is c...
Do you transfuse anemic head and neck cancer patients undergoing chemoradiation?
DAHANCA 5 trial and combined analysis from DAHANCA 5 and 7 showed no benefit to transfusion, so only if symptomatic or other clinical consideration.
Do you routinely recommend prophylactic cranial irradiation for stage I small-cell lung cancers treated with lobectomy and adjuvant chemotherapy?
PCI was 'associated' with better long-term survival even in stage 1, and age and size factors do not seem to matter. However, as the information gets divided, fewer patients fall into each cohort.A recent study published in the JCO, analyzing over 1,000 patients in the NCDB, found that thoracic radi...
Do you recommend delayed versus immediate breast reconstruction in patients who will require post-mastectomy radiation therapy?
There is no absolute answer for this question as it has not been studied prospectvely for us to know what is the best approach. The approach to some extent is driven by patient's choice, her reconstruction options and expectations from reconstruction outcome. In general if we know for sure patients ...
Do you offer hypofractionated courses of radiation with temozolomide for "elderly" patients with GBM?
The ASTRO GBM guideline states the following with regard to elderly patients:“Given the absence of proven superiority for conventionally fractionated radiation therapy, the panel recommends hypofractionated radiation therapy for elderly patients with fair-good performance status (high quality eviden...
When treating a high grade neuroendocrine tumor of the rectum with involved pelvic lymph nodes, do you use the same approach (dose, fractionation, concurrent chemotherapies) as you would for a small cell lung cancer?
I have simply used standard radiation dose and technique with platinum/etopiside or CPT/cis. Twice a day fractionation could be very difficult to tolerate. The proctitis and small bowel toxicity would probably be too severe.
How do you incorporate the recent proposed guidelines for using a prostate cancer "Grade Grouping" system (i.e. scores 1-5) into your clinical practice?
As theMedNet is a less formal venue for discourse I will do away with any pretense and answer the question honestly. I have no idea how I or anyone should incorporate this new system into practice. Although validated, the new system has not been used in randomized trials and one musn’t be overly dog...
Are there any situations where you would specifically not use IMRT/VMAT to treat post-operative gynecologic malignancies?
The short answer is no. Although,taking into account internal organ motion - ie., bladder and rectum - is very important to define the correct ITV and PTV. Our new atlas will be available soon and will build on our previous publication.
Does the better prognosis associated with p16+ H&N cancers relate only to patients who are treated with RT +/- chemo?
The good prognosis of HPV-related OPC pts is observed also in surgical series. Surprisingly, series of TORS find no ststistically differences in TORS for early stage HPV(+) or (-) pts (Cohen MA, Weisndtein Gs et al, Head and Neck 2011), and it is possible that surgical resection of HPV(-) cancers gr...
Given the results of the recently published GETUG 16 randomized trial, should all men undergoing salvage prostate radiotherapy receive concurrent hormone therapy?
I'm not surprised to see this question posted on The Mednet. GETUG 16 was recently published (Lancet Oncol. 2016 May 6.) and provides additional prospective information regarding the role of ADT in the managment of salvage prostatectomy cases. Not to nitpick over the article excessively, but I did n...