Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What are the current official guidelines regarding managing patients during COVID-19?
Here are some guidelines and FAQ from professional societies: NCCN: https://www.nccn.org/covid-19/default.aspx ASTRO FAQ: https://www.astro.org/Daily-Practice/COVID-19-Recommendations-and-Information/COVID-19-FAQs ASCO Coronavirus Resources: https://www.asco.org/asco-coronavirus-information
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 is your approach to women with breast cancer who opts for a staged approach with up-front lumpectomy and SLN biopsy (pN-) when there are indications for adjuvant radiation therapy but she plans for a later mastectomy (=>6 months)?
I would not offer RT if planned for mastectomy in 6 months, as based on phenotype, median time for recurrence is 2 to 5 years, and RT can also negatively impact the cosmetic outcome with reconstruction.
How do your PMRT recommendations change with ITCs after neoadjuvant chemotherapy if they had SLNB only versus ALND in light of B51?
Data such as from Dana-Farber/Brigham and Women’s Cancer Center and the National Cancer Database (Wong et al., PMID 31228134), as well as the OPBC-05/ICARO study (Montagna et al., PMID 39509672), indicate that patients with isolated tumor cells in axillary nodes after neoadjuvant chemotherapy (ypN0i...
What is the rationale for the recent change in the NCCN criteria for very high risk prostate cancer?
As the new Chair of NCCN's Prostate Cancer Guidelines, I am happy to answer this.The purpose of risk groups is not merely to be a prognostic divider, but to help guide treatment. Many systems have been developed that have greater prognostication than NCCN risk groups, such as STAR-CAP (which is supe...
Are there any scenarios in which you would offer SBRT as your preferred treatment approach for appropriate candidates with intermediate risk prostate cancer?
Based upon the PACE-B trial, 40 Gray to the prostate, 36.25 to the PTV, which was compared to standard or moderately hypofractionated radiation, and documented non-inferiority. It is reasonable to consider stereotactic radiation therapy as a standard of care for intermediate-risk prostate cancer. If...
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 ...
Do you typically recommend placement of a rectal spacer prior to definitive radiotherapy, regardless of dose/fractionation?
In my opinion, the potential and role of rectal spacing in minimizing toxicity is not debated. The concern about spacing relates to risks of the procedure and its associated additional cost to treatment may be greater than the potential improvement in toxicity for the patient. As we continue to show...
Do TTFields work synergistically with SRS for patients with brain metastases?
Based on the presented data from the METIS trial, yes, TTFields works synergistically with SRS for patients with NSCLC brain metastases. It is not clear on the mechanism of action. It appears there is even greater synergy with use of ICI. One hypothesis is whether there is enhanced immune response, ...
What criteria do you use in deciding whether or not to treat the pelvis in prostate cancer?
NRG/RTOG 0924 - The end of elective nodal RT in localized prostate cancer? Top line results: NRG/RTOG 0924 is a very large phase III randomized trial powered for overall survival (OS) to determine if there is a benefit of the addition of whole pelvic radiotherapy (WPRT) to prostate RT plus ADT. This...