Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you recommend treatment of the entire extent of the hardware and/or bone when treating a bone metastasis that has received pre-irradiation surgical stabilization?
In the era where imaging like MRI, CT scan, or PETCT is routinely performed, we have not been chasing entire hardware and only treating image based disease with a generous margin. I would not worry about microscopic disease along the entire hardware when the goal and endpoint is palliation.
In what situation would you obtain an MRI before adjuvant or salvage RT to the prostate bed?
In my response, I will assume that the your treatment planning is CT based, as would be the case in most centers, including mine. In the adjuvant setting, I do not get MRIs, since by definition the PSA is undetectable and I do not feel that an MRI will give you useful information beyond what you wou...
Do you have a size criteria when treating lung oligometastases with SBRT?
A lesion 3-5 mm is difficult to characterize on PET, low yield for a biopsy, and non-specific, even if it developed in interval scans. Multiple 3-5 mm lesions could also be from an infectious/inflammatory condition. If the lesions are likely from cancer (i.e. new lesions with rising tumor markers, o...
What is the role of adjuvant radiation therapy for stage III melanoma in the era of adjuvant Opdivo?
I think the role of adjuvant radiotherapy in stage III cutaneous melanoma is difficult to define at this time (June 2019). To be clear, the TROG trial mentioned above showed that adjuvant lymph node basin radiotherapy after therapeutic lymphadenectomy can decrease the chances of lymph node basin dis...
Would you offer empiric lung SBRT for two growing FDG-avid lung lesions in a patient with severe COPD on oxygen?
This is a good question! The short answer is yes, most likely. Many patients are too high-risk to receive biopsies; this is decided by surgery/pulm/IR. Unless the patient has contraindications to RT or something like severe IPF (where treatment may be worse than the disease), I would likely offer th...
Do you offer LDRT for psoriatic arthritis, rheumatoid arthritis, or polymyalgia rheumatica or fibromyalgia?
I have treated for RA and PA. I have not had any referrals for PMR or fibromyalgia. I have not considered for fibromyalgia, as I don't understand the condition well. For RA/PA, in many cases, they have not had any relief from medications, therapy, NSAIDs, and relying on opioids and other, at times, ...
Is there any benefit to the use of low dose radiation in patients with osteoarthritis who have already undergone joint replacement?
I've treated a lot of patients with LDRT for OA, but not many with joint replacements. The ones that still have pain after a joint replacement - I have told them that mechanistically it does not make a whole lot of sense to treat - I don't imagine it will have that same anti-inflammatory effect, as ...
Do you continue androgen receptor pathway inhibitors in patients receiving Lu177-PSMA for metastatic prostate cancer?
Yes, ARPIs can be continued during treatment. Just over half the patients on the VISION trial remained on enzalutamide or abiraterone. Outside of the ENZA-p trial (Phase IIR), there is no good evidence for or against the use of concurrent ARPI to my knowledge, although there really should not be syn...
Given the secondary analysis of RTOG 0617, should IMRT be considered standard of care in locally advanced non-small cell lung cancer?
The secondary analysis of RTOG 0617 (Chun et al. JCO.2016) supports the notion that IMRT should be the standard of care for the treatment of locally advanced non-small cell lung cancer (NSCLC). This study (0617) compared chemotherapy +either 60 Gy or 74 Gy of conventionally fractionated RT. The seco...
How do you apply the concept of a lumpectomy bed boost in the setting of oncoplastic surgery?
This is a very common and often frustrating issue in patients I absolutely feel the need to boost (younger, larger tumors, high grade). I now consistently request my surgeons place a 3D tissue marker (brand name Biozorb) which preserves the location of the lumpectomy despite oncoplastic reconstruct...