Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you ever consider stopping immunotherapy in a patient with metastatic melanoma after achieving a good response?
Yes, I would consider stopping immunotherapy in a patient with metastatic melanoma after achieving a good response.Data of 655 melanoma patients treated in pembrolizumab phase 1 KEYNOTE-001 study has shown 95 patients (14.5%) achieved CR after a median follow-up of 32 months. Treatment was discontin...
How do you follow patients after SBRT for NSCLC?
When we started our lung SBRT practice almost 13 years ago, the follow up schedule was based on trying to measure the benefits and impact of the therapy in a fairly structured fashion so that we could develop expertise in understanding outcomes, radiographic changes, patient experience, and treatmen...
For patients with locally advanced rectal cancer who desire organ preservation and can tolerate fluoropyrimidine but not oxaliplatin, what is the appropriate treatment approach?
For patients with locally advanced rectal cancer who desire organ preservation and cannot tolerate oxaliplatin, the appropriate treatment approach would be neoadjuvant, long-course radiotherapy combined with fluoropyrimidine-based chemotherapy. After neoadjuvant treatment, patients are ev...
Is it reasonable to offer observation with MRI rather than immediate PCI for patients with limited stage SCLC?
The Meta-analyses reported a survival advantage in LD SCLC. About 10% present with isolated BM, and 60% fail in the brain without PCI. Decreased cognition was reported by 24 months by Arriagada. Some have noted decreased cognition post WBRT in both NSCLC. There has been advocates for observation ...
Have you encountered severe truncal and bilateral lower-extremity edema after pelvic radiation for a rectal neuroendocrine tumor?
I have seen something similar after radiation to the lower retroperitoneal nodal chain, where there was likely progressive fibrosis that obliterated the lower IVC to the point that nothing could be done. Also, it is possible, albeit very unlikely, that rectal NETs produce serotonin in sufficient qua...
How do you approach ADT use in a salvage RT patient with biochemical recurrence whose Decipher score is very high but PAM50 subtype is non-luminal B?
Yes, especially if PSA is more than 0.5 ng/mL.
Are there any volumetric constraints associated with toxicity in the dose range that is moderately above prescription (i.e. 30-35 Gy range), when planning hippocampal-sparing whole brain radiation?
This is an important question worth some discussion. As the question mentions, clinical trials of HA-WBRT have permitted a hot spot of 133% of the prescription dose of 30 Gy (or 40 Gy) to D2% of the whole-brain parenchyma as an acceptable protocol variation. Importantly, none of these trials have de...
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...
Are you altering your use of Active Breathing Coordination for breath hold technique patients in light of the COVID-19 pandemic?
We use DIBH, and this has not changed anything in our practice.
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...