Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What resources/ancillary staff do you utilize for school re-entry after cancer treatment to decrease anxiety, improve self-confidence, and support emotional functioning?
Facilitating school re-entry for children and adolescents undergoing cancer treatment is an important component of comprehensive care. Maintaining engagement in school can help preserve a sense of normalcy and mitigate feelings of isolation and loneliness. However, the transition back to school may ...
How long after achieving a CR would you consider stopping pembrolizumab in metastatic melanoma?
Based on Keynote 001 and more recently on Keynote 006, where we observed sustained remission in more than 90% of the patients who had stopped pembrolizumab for complete response, we usually consider stopping pembrolizumab in patients who have a confirmed complete response (this means that we have tw...
Are there any alternative, hypofractionated RT courses for patients with DLBCL that can be used during the COVID-19 pandemic?
ILROG recently came out with guidelines pasted below: Synopsis of ILROG Recommendations for Administering Radiotherapy for Hematological Malignancies During Emergency Conditions of the COVID-19 Pandemic • We are facing an increased demand for RT to substitute or complement systemic therapy deemed i...
Do you prescribe respiratory muscle training (RMT) devices to patients with dysphagia?
We encounter dysphagia frequently in our patients with Parkinson's disease and other movement disorders. If there are any concerns about swallowing or aspiration, my first step is to refer to Speech Therapy for evaluation, and I defer to their expertise for specific treatments from there. That said,...
How does the POSEIDON meta-analysis results influence your decision on which patients should receive hormone therapy with post-operative radiotherapy for recurrent prostate cancer?
POSEIDON is another landmark analysis from the MARCAP consortium. It adds to the seminal work performed in localized prostate cancer (Kishan et al., PMID 35051385), which serves as the reference study for the use and duration of ADT with radiotherapy, but now in the post-prostatectomy setting.The st...
What is your preferred dose to gross lymph nodes when treating non-metastatic high-risk prostate cancer?
I treat the grossly involved node as high as I can, while respecting OAR constraints, up to the dose for the prostate. I tend to favor zero or minimal PTV margin (depending on the proximity of OARs--usually bowel) and allow the penumbra to serve as a functional "PTV."
How do you approach the decision to boost patients diagnosed with DCIS?
Based on prospective and also retrospective data Chua, AACR Volume 81, Issue 4 Supplement, pp. GS2-04. We would recommend for high grade, < 50 years and close margin and in the era of genomic testing to patients with high genomic score.
Do you attempt to spare the submandibular glands in head and neck IMRT?
I do too. The primaries I consider electively treating 1B nodal station are: oral cavity, nose and anterior nasal cavity, lip, medial cheek/mid face, and node positive parotid. The submandibular gland itself is devoid of lymph nodes and is rarely ever involved by Sq cell Ca (versus the parotid gland...
How do you interpret recent large retrospective analyses comparing radical prostatectomy vs. radiation for prostate cancer?
There have been numerous comparisons of RT vs. RP from a variety of study teams with various conclusions, and it often seems like the principal conclusion of the study is best predicted by the subspecialty from which the authors originated (urology vs. radiation oncology). As the question partially ...
Can a PSA bounce be seen shortly after SBRT to prostate cancer oligometastases while on androgen deprivation therapy?
I would not consider it a "bounce" if it happens shortly after treatment because the timing of a post-treatment bounce is later. If the PSA is higher than pre-treatment baseline soon after metastasis-directed SBRT, then you are likely observing one of two scenarios. First, the pre-treatment baseline...