Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the best treatment approach for locally advanced (T3+ and/or N+) rectal cancer status post low anterior resection in a patient who has a remote history of seed implant for low risk prostate cancer?
These treatment decisions are best discussed within a multidisciplinary group. If the tumor is located on the anterior rectal wall and the prior high dose from the implant cannot be spared, there is a risk of rectal bleeding with re-irradiation if surgery is not performed and urinary fistula regardl...
How would you manage recurrent laryngeal cancer after previous larynx xrt if surgical salvage not an option?
Re-RT for recurrent laryngeal cancer when surgery is not an option was first proposed by CC Wang (IJROBP 1993;26:783-5). He reported reasonable local control rates and stated, at the conclusion of “Radiation Therapy Results†in his paper, that “significant radiation sequelae… were not encoun...
Is MRI necessary to distinguish prostate from rectal spacer (SpaceOar) when planning for definitive prostate radiation therapy?
Important question given the increasing popularity of the spacer gel! T2-weighted MR imaging is by far the best way to distinguish prostatic tissue from the hydrogel spacer. It's also a critical tool to assess accurate and high-quality placement of the spacer gel, namely to determine that is...
How do results from NSABP B-39 influence your practice for APBI compared to WBI in early stage breast cancer?
With respect to clinical outcomes, the results of B-39 confirm what the data previously available demonstrated. APBI is an appropriate option for appropriately selected patients. A less than 5% recurrence at 10 years is excellent and paired with the updated RAPID results provide confidence that part...
Do you make any modifications to your treatment plan for older patients undergoing prostate SBRT?
At UCLA, we do not make treatment modifications of prescription dose or change our dose constraints for OAR in our elderly patients (> 75 y.o.) undergoing prostate SBRT. We have not noticed a difference in toxicity in older patients. Admittedly, this has not been studied in our cohort of patients in...
How would you treat very locally aggressive rectal cancer extending into muscle and causing internal iliac tumor thrombus, in a patient who is not a surgical candidate?
I would treat with chemoradiation, 50.4 Gy/28 fx using a 3D conformal technique and standard rectal cancer volumes. The lumbosacral plexus prevents doses higher than 60 Gy, and in general there not much evidence of dose response between 50Gy and 60Gy.
Is multifocal disease an indication for RT in an elderly patient with early stage and otherwise favorable breast cancer?
IBTR for upfront unifocal and multifocal disease is similar and would not change recommendations for me if all other factors were favorable.
What radiation regimen do you use to palliate bulky melanoma metastases involving the oral cavity?
I like this 9 Gy x 3 melanoma regimen by Dr. Jens Overgaard from Denmark:https://www.ncbi.nlm.nih.gov/pubmed/4044346It's an oldie from 1985, but uses roughly the same regimen (9.5 Gy x 3) subsequently found to be the trigger of an abscopal response in a patient progressing on ipilimumab, as reported...
Is PORT recommended for incidentally found N2+ NSCLC after lobectomy for oligoprogressive metastatic NSCLC?
I would say it should probably be used very selectively in this population. We routinely use PORT for stage 3 patients who have incidentally discovered N2 nodes, but I try to keep in mind that that evidence supporting its use is not strong, even in the curative setting. There's a consistent LC bene...
When do you consider neoadjuvant radiation for inflammatory breast cancer?
I utilize neoadjuvant radiation only in the setting of a patient inoperable following neoadjuvant chemotherapy. I have used xeloda + radiation in such situations as well.