Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
For gross hematuria from a primary bladder tumor, what palliative radiation regimen would you recommend?
I found that 36 Gy/6 Fx delivered weekly is a great option for palliation.This has been used in curative system, as well, but I find it to be particularly helpful in elderly patients or those with travel issues. There is a phase 2 study in patients who are medically inoperable and the local control ...
How do you manage a FIGO stage IB dedifferentiated endometrial carcinoma that is MMR deficient and p53 wt?
Aggressive disease. Favor chemo plus IO (MMR-d) (Van Gorp et al., PMID 39284383) followed by EBRT.
What is your approach for treating oligometastatic head and neck cancer in patients with a good performance status?
In patients with limited metastases and locally advanced head and neck cancer, we routinely offer definitive radiation therapy to the local disease, consider treatment of the metastatic site, and discuss addition of concurrent chemotherapy. The majority of these patients will benefit from locally d...
How frequently do you observe transient enlargement of a vestibular schwannoma after SRS?
Transient enlargement of a vestibular schwannoma is not uncommon, and it's appropriate to reassure patients. I image these patients once every 6 months until radiographic stability, and then once yearly.
How do you counsel your breast-cancer survivors about weight-loss/dietary modifications?
Normal body mass index (BMI) and maintenance of weight is associated with a more favorable outcome (in many series both cancer-related and non-related) compared to higher BMI. Similarly higher level of exercise and metabolic equivalent (MET) is also associated with better outcome in many observation...
When would you recommend abiraterone concurrently with RT for high-risk prostate cancer?
The trial got published in NEJM. It confirms survival advantage and skeletal mets advantage with abiraterone for metastatic disease similar to the Latitude study. This will certainly be an option for metastatic disease at presentation (along with docetaxel until comparative studies comparing docetax...
What radiation dose do you typically use for relapsed DLBCL following 6 cycles of R-CHOP?
There are several potential scenarios, all with different answers, so I will illustrate a few.Historically, second-line chemotherapy (e.g., R-ICE) would first be pursued for relapsed DLBCL, and if the disease was still responsive to chemotherapy (CR or PR), then the patient would proceed with high-d...
How do you treat newly diagnosed low volume metastatic hormone sensitive prostate cancer in light of new data from STAMPEDE presented at ESMO 2018?
In the prespecified subset of men with mHSPC and low volume of metastases (CHAARTED criteria of 4 or fewer bone metastases and no visceral metastases), there was a 32% improvement in overall survival (HR 0.68 95% CI 0.52-0.9) which was statistically significant and is clinically significant. Given t...
What is your approach to locally advanced pancreatic cancer that has not progressed after neoadjuvant chemotherapy +/- chemoradiation but remains unresectable?
NRG GI011 was recently activated across the NCTN and will test ablative radiotherapy in this setting. This is a pragmatic and potentially practice-changing trial. Consider activating it at your center. Here is a nice summary from the PI @Dr. First Lasthttps://www.youtube.com/watch?v=MNsS7pHqZIk.
Is 2 Gy x 2 (or the "boom boom" regimen) appropriate for treating patients with low volume stage I MALT lymphoma?
I disagree. My answer is no. The quoted series contains very few patients with short follow-up. I am not aware of any large series with long follow-up of MALT pts with early stage disease treated with curative intent in this fashion. A randomized trial of 2gy x 2 for early-stage follicular lymphoma ...