Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Given COVID-19, is there a good hypofractionated regimen for postmastectomy radiation for locally advanced breast cancer?
In light of COVID-19, we offer 2.66 x 16 PMRT with comprehensive RNI. This regimen is under study in ALLIANCE A221505, commonly known as RT-CHARM. Primary endpoint is reconstruction complications at 2 years. We discuss with reconstructed patients (most all will take if offered). Routinely given to u...
How will the LORETTA and COMET trials influence your treatment of low-risk DCIS?
Clearly, postop RT can be avoided, but the pink elephant in the room is, can 5 years of endocrine therapy likewise be avoided? Treatment de-intensification requires addressing all aspects of therapy, particularly if one argues against adjuvant therapies for reasons of cost and toxicity. I can't reca...
Would you use upfront atezo/bev in a patient with HCC and untreated hepatitis?
Yes. I would not have concerns. For HBV, I would start treatment before or simultaneously. Studies have varied by protocol about the HBV viral load being under 500 or 100 but it is not clear this matters. There have not been flairs reported. In regards to HCV, again, not an issue for me.
Does the presence of cribiform histology at biopsy in prostate cancer affect your management in an otherwise intermediate-risk prostate cancer?
There have been no trials on this specific question, so there is room for debate and more science (hoping our recent grant submission in this area gets funded...). Here is my current thinking. This is for generally healthy patients with long life expectancy (≥10 years, but especially if ≥15 years). ...
What is the optimal management of pain and loss of function due to pathologic compression fractures?
I explain to my patients if they have an acute compression fracture that they are likely to experience pain for approximately 2-3 weeks that will gradually resolve. I often give them some type of pain relief using Tylenol or ibuprofen and if severe, a more potent analgesic for a short period of time...
Given the recently published results of PEACE 2, under what scenario would you offer pelvic radiotherapy for high-risk/very high-risk prostate cancer?
Although PEACE-2 was presented at GU ASCO, to my knowledge it has not yet been published other than in abstract form, and the results of the arms in PEACE-2 comparing prostate only vs whole pelvic RT were not presented, so I don't think PEACE-2 sheds any light yet on the question of whether or not t...
Would you consider offering salvage radiation to a patient with castrate resistant prostate cancer who has never had local therapy and has no evidence of lymph node or distant metastasis?
It's hard to give a great answer without knowing more information, such as the PSA, Gleason score, and T-stage at presentation, why he was treated with androgen deprivation alone up front, what AD he was treated with, how long he was under treatment before he became castrate resistant, and what is t...
Is it appropriate/safe to utilize bolus with ultra-hypofractionated breast radiation?
There are no data I know of on using bolus with the FAST-Forward regimen. I would be very reluctant to do so because of the lack of time for healing of the skin between fractions and concern about long-term hyperpigmentation and telangiectasias if the patient had breast-conserving therapy. However, ...
How do you monitor for cardiac toxicity in patients taking osimertinib?
There are multiple studies that have explored the issue of cardiotoxicity from osimertinib. A large single-center retrospective observational cohort series from Taiwan, (n=401) compared a matched cohort of patients treated with osimertinib (n=253) to those treated with other EGFR TKIs (n=195) and fo...
What would your approach be in a man currently on treatment for high-risk prostate cancer with ADT who does not have castrate levels of testosterone?
Yes, I would try alternative agents. If using Lupron, consider relugolix, degarelix, high-dose bicalutamide, or even adding an ARSI.