Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you recommend matchline shifts when treating abutting photon and electron fields when treating the chestwall?
There are various way to do it We match photon and electron at skin with no planned overlap. We feather twice during the course with 5 mm shift on either site to spread hot and cold spot. Without shifts there is increased reaction at the match line with increased fibrosis
How do you decide between enrolling an oligometastatic NSCLC patient on LU-002 versus treating them with SBRT off trial?
On behalf of @Dr. First Last, MD, PhD and @Dr. First Last, MDThis question is very important and goes towards the question of equipoise from the perspective of the physician and patient for enrollment on NRG-LU002, accounting for recent data from Gomez et al and Palma et al presented at ASTRO 2018. ...
Would you consider hormonal therapy and no RT in an elderly pt who developed a contralateral early stage, ER+ breast cancer while on Tamoxifen for previous breast cancer?
I agree with @Dr. First Last. I view these cases as more aggressive as the malignancy developed while on hormonal therapy. Of course each case depends on the individual performance status and goals of the patient.
Do you consider additional chemotherapy or durvalumab after definitive concurrent chemo/RT for Stage II NSCLC for patients who are not surgical candidates?
Staging is man-made and somewhat capricious and as stands now essentially completely unmoored from biology in NSCLC. Durvalumab is obviously very moored to biology in NSCLC. There are times we "extrapolate" in oncology; it's tough not to do this in settings where no *specific* data exists but "adjac...
Would you offer APBI in patients with a high Oncotype who are otherwise considered “suitable” per ASTRO guidelines?
I would be reluctant based on limited data showing high oncotype predicting for increased risk of local relapse even after RT. I would favor treating with whole breast plus a boost.
Would you extrapolate data from PACIFIC trial for unresectable disease to consider consolidation therapy with durvalumab for Stage III NSCLC with single-station N2 disease amenable to lobectomy?
I agree with both answers above. The question about adding durvalumab after chemo-RT and lobectomy continues to come up. I would not extrapolate the data from PACIFIC to this situation. First, its important to point out that its not indicated in this situation - the approval for durvalumab in the US...
How do you approach definitive radiation for prostate cancer in a patient with perineal urethrostomy?
Long Answer: I probably treat about 2 patients a year with perineal urethrostomy, usually due to recurrent penile cancer post penectomy. Keep in mind that when we treat prostate cancer, the penile urethra routinely receives ~78Gy EQD2 and with brachytherapy even higher biologically equivalent doses,...
How do you sequence follow up mammograms in patients undergoing breast cancer treatment?
In the followup of patients treated with breast conservation therapy, continuation of yearly mammograms is standard practice, even if the cancer in question was not seen mammographically. It would be quite unusual to be undergoing RT when the yearly mammogram was due, since even with the diagnosis o...
What are your indications for radiotherapy in children with pleomorphic xanthoastrocytoma?
Pleomorphic Xanthoastrocytoma is unique among other pediatric low grade gliomas in that it there is a high frequency of targetable alterations including BRAF V600E alterations and that there appears to be an increased risk of transformation relative to other pediatric low grade glioma histologies (P...
What criteria do you use when considering treating the pelvic nodes in a salvage prostatectomy case?
Perhaps I am biased because I have conducted research in this area, but I believe this is one of the more intriguing questions in our field. Particularly, given how many men are referred for post-prostatectomy salvage radiotherapy for a rising PSA. I had enthusiastically enrolled patients onto the R...