Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you offer treatment of prostate/oligomets upfront with systemic therapy for oligometastatic de novo prostate cancer?
There's no right or wrong answer here, and I've done both options (treat everything up front and treat sequentially) based on disease sites and volume, and patient symptoms and priorities. I can share how I think through the decision-making: Do they qualify for prostate RT based on STAMPEDE and life...
How would you manage a small posterior vaginal defect noted at the time of cervical brachytherapy?
If it is from a disease, I would continue brachy as planned and address the defect based on response and healing. If unrelated to disease, I would have it sutured and continue brachy as planned.
What would be the approach for radiation treatment of a sarcoma of a finger?
The correct approach for definitive management is an amputation or perhaps, if possible, a digit-sparing resection with preoperative RT. As always, the crux with organ-sparing approaches is that we need to leave an organ that is both disease-free and functional, and I am skeptical that definitive-in...
Is it acceptable to treat patients with limited, asymptomatic brain metastases and EGFR-mutant NSCLC with upfront TKI?
Though some clinicians have been exploring the idea of targeted therapy for EGFR mutant brain metastases, this has been done in the absence of strong evidence. Reasons for pushing this idea are that sometimes the lesions seem to respond, and this has been seen in some single arm studies and anecdota...
For an non-operative patient with IB1 cervical cancer, would you recommend RT alone or concurrent chemoRT for definitive therapy?
I usually favor RT alone as local control and the outcome is excellent unless they have adenocarcinoma, a suspicious pelvic node, or multiple high risk features (high grade with LVSI on bx).
When planning definitive SBRT for localized RCC, how do you approach cases where OAR constraints (such as bowel) compromise PTV coverage?
SBRT for localized renal cell carcinoma is a good option when the patient is not a candidate for nephrectomy. In cases where the lesion is directly adjacent to important normal structures, dose reduction is reasonable. If you believe this to be too large of an area, you could consider neoadjuvant sy...
For a patient with intracranial mets for ES-SCLC who undergoes resection, do you routinely offer post-op SRS to the cavity, or do you proceed with WBRT?
While Whole Brain Radiation Therapy (WBRT) has been the standard, stereotactic radiosurgery (SRS) to the surgical cavity is increasingly being used to minimize neurocognitive decline. However, the issue is especially more nuanced for an ES-SCLC (we don't know whether the primary has been controlled ...
Do you use either memantine or hippocampal sparing technique to preserve cognitive function when giving whole brain radiotherapy?
Dr. @Dr. First Last and I put together the response below:We use memantine and hippocampal sparing technique for all brain metastasis patients who are planning to receive WBRT. This is based off the recently published phase III trial NRG CC001 that found hippocampal avoidance WBRT plus memantine res...
In patients with advanced endometrial cancer who you plan to treat with chemotherapy + immunotherapy (per GY018 or RUBY), how and when do you utilize adjuvant EBRT and/or brachytherapy?
Reading the question at face value - does advanced endometrial cancer mean stage IVB? III/IVA? If IVB, there is not routinely a role of 'adjuvant' EBRT or BT.Given the discussion of adjuvant therapy, I presume the question is asking for the small fraction of RUBY and GY-018 patients who were stage I...
For patients with cT1-T3 cN0 cM0 mid/low rectal cancer seeking organ preservation, what treatment approach do you recommend?
This is an important question; however, the answer is unknown. The key outcome that should be the focal point for the best treatment option, is which treatment strategy results in the most optimal patient reported quality of life and bowel function. Currently, this remains void of prospective, rando...