Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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...
Would you offer hippocampal sparing whole brain radiation for patients with brain metastases due to ES-SCLC?
Until we have built-in auto-segmentation, I find the RTOG contouring atlas very helpful for manual contouring of the hippocampus. I tend to use the lateral ventricle as my main landmark, and look for the circle of gray matter located medial to it. Once I've drawn a hippocampus, I'll look at it in th...
Are there any trials currently studying low-dose RT for confirmed COVID-19 infections with associated pneumonia?
This is a joint reply from a team developing a prospective trial to answer this question:Minesh Mehta, Arnab Chakravarti, Walter Curran Jr, James Fontanesi, Vinai Gondi, Michael Kasper, Deepak Khuntia, Rupesh Kotecha, Ramesh Rengan, Leland Rogers, Charles B. Simone II, James Welsh, George WilsonThis...
Should we be stopping new starts of patients who can be triaged for 2-3 months like prostate cancers on ADT when significant community spread of COVID-19 is detectable in our area?
I would for those patients requiring ADT, which is the way I interpreted the question. I want to elaborate more because @Dr. First Last brought up other scenarios we should consider and he brings some more good points: Many patients could get active surveillance for a period of time before ADT is co...
Would you perform unilateral or bilateral hippocampal avoidant whole brain RT in a patient with a prior SRS to a small hippocampal metastasis?
I would recommend bilateral HA-WBRT and memantine in this situation. The role for HA-WBRT is shrinking over time with a diminishing patient population between the expanding role of SRS for multiple brain mets and no role for cranial RT for poor prognosis patients with no/limited systemic therapy op...
Is long term ADT now the standard of care with salvage prostate bed RT?
The dreaded hormone question...After 40 years of embarking on extremely well designed randomized trials, we still are confused about the who, what, when of ADT. Will RTOG 9601 create a new care standard? As @Dr. First Last said, I think we will see increased utilization. I have been using bicalutami...
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...
Do you still routinely offer post-op radiation after bone fixation?
This information would not change my practice pattern. I would be interested to know the delineation of the target volume and if all hardware was targeted, as I do not see any radiation details on dose selection/target delineation/etc. Of note, in this series, the median time to initiation of PORT w...
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 treating the whole brain with hippocampal avoidance, do you ever deliver SIB to gross disease?
There have been several papers and an ongoing trial evaluating the safety and efficacy of including SIB to macrometastatic disease with HA-WBRT. A recently published trial from the UT-Southwestern team was a single-arm phase II trial, which treated 50 brain metastasis patients with HA-WBRT to 20 Gy ...