Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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.
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...
What is the optimal duration of ADT in high-risk prostate cancer treated with RT+ADT?
Nabib et al. presented "Final Results" of the 18 vs. 36 month ADT trial for high-risk M0 prostate cancer in Chicago during ASCO 2017. This trial has the potential to be practice changing, since most men receive 2+ years of ADT during RT-ADT for high-risk disease. 630 patients were randomized and OS ...
What are best practices for radiation oncology patient and staff precautions with the COVID-19 pandemic?
COVID Update 1/30/21 Wow, it's been almost a year. Here are some updates from our practices at University of Maryland. We have successfully treated both PUIs and COVID+ patients at all of our practices. We have yet to have a patient to staff (or staff to patient) transmission. We do not break patien...
What factors do you consider when selecting dose/fractionation for whole brain radiotherapy?
I assume this question is for brain metastases patients who are not eligible for hippocampal avoidance WBRT (ineligible criteria including but not limited to - mets 5 mm within either hippocampus, germ cell/small cell/lymphoma, leptomeningeal disease, etc.) - my default WBRT dose fractionation is 30...
Do you offer consolidation chemotherapy prior to durvalumab in locally advanced, unresectable NSCLC?
I do not offer consolidation chemotherapy to patients prior to durvalumab in patients with locally advanced, unresectable NSCLC. The PACIFIC trial was a randomized phase III trial that established the role of consolidation durvalumab after definitive chemoradiation for patients with stage III NSCLC....
How do you sequence radiation and capecitabine in breast cancer patients receiving adjuvant capecitabine for residual disease after neoadjuvant chemotherapy?
According to personal communication with Dr. Masakazu Toi (June 13, 2017), the corresponding author of the CREATE-X NEJM publication, radiotherapy was administered prior to capecitabine in the majority of cases on this study. It is worth noting that in CALGB 49907, a randomized trial comparing capec...
Should hippocampal-avoidance WBRT be the default option for WBRT?
I think this is a difficult question to answer as a lot depends on the particulars. Here's a list of some of those issues: Radiosurgery is very easily administered & frequently free of toxicity. Systemic agents are showing improved efficacy in the brain. Surveillance MR imaging = lower incidence of ...
How are you using predictive tests such as DCISionRT (PreludeDx) or OncotypeDX DCIS in the management of DCIS?
Advantages: It's a relatively cheap, simple assay to better individualize risk of DCIS. Not only prognostic like Oncotype DCIS but also predictive of the absolute benefit of radiation. Supposed to be a better risk assessment tool than traditional clinical pathologic factors. Can identify those who ...
When should you use single-fraction radiotherapy for spinal cord compression?
The SCORAD III trial is practice changing. But I do NOT plan to treat ALL patients with spinal cord compression with a single fraction of 8 Gy now. Here is why: SCORAD III is extremely important new study for the management of metastatic epidural spinal cord compression (MESCC) for patients with sho...