Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is there any role for ctDNA testing after surgery or SBRT for Stage IB NSCLC to determine the need for adjuvant chemotherapy?
This is another emerging use for ctDNA that has shown promising results in small studies. The TRACERx consortium in the UK looked at the evolution of early NSCLC over time in 100 patients who underwent resection. They performed multi-region sampling and whole-exome sequencing and created patient-spe...
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...
Given the recently published results of PEACE 2, under what scenario would you offer pelvic radiotherapy for high-risk/very high-risk prostate cancer?
Although PEACE-2 was presented at GU ASCO, to my knowledge it has not yet been published other than in abstract form, and the results of the arms in PEACE-2 comparing prostate only vs whole pelvic RT were not presented, so I don't think PEACE-2 sheds any light yet on the question of whether or not t...
In light of the recent results of FAST-Forward, particularly the 5-year results of the nodal substudy, would you consider offering ultra-hypofractionation for WBI + RNI?
While I think that the data on moderate hypofractionation is mature enough (40 Gy in 15 fractions or 4256 in 16 fractions) to consider moderate hypofractionation in many patients undergoing regional nodal radiation or PMRT, I personally am not yet comfortable routinely offering Fast Forward to this ...
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...
Do you use any strategies to minimize loss of taste from radiation for oropharyngeal cancer?
In a prospective longitudinal study of QoL in OPC patients receiving chemo-IMRT, where patient-reported dysgeusia was one of the items, we reported a significant association between severe dysgeusia and mean radiation dose to the oral cavity (P=.005) (Sapir et al., PMID 27473816). NTCP for severe dy...
Is there any role for adjuvant radiotherapy for resected multistation N2 atypical carcinoid tumor of the lung?
Carcinoid tumors, typical or atypical, are not very responsive to radiotherapy. Add the feature of “multi level N2 nodes”, the prospect of local and systemic recurrence increases. So to many this bolsters the logic to offer thoracic radiotherapy. These tumors are also not very responsive the chemot...
What salvage EBRT dose would you recommend for radiation-naive patients with Hodgkin's Lymphoma who are refractory to chemotherapy and immunotherapy and decline to undergo transplant?
This is likely a palliative scenario, thus, I would try to limit toxicity and time spent on treatment. 30-36/3 appears reasonable, in my opinion.
Are CHEK2 mutations a contraindication for breast conservation therapy with lumpectomy + RT?
Among women with early-stage breast cancer and moderate penetrance breast cancer susceptibility genes, such as CHEK2, decisions about breast surgery are largely based upon personal preferences. According to data from large population-based studies, women with CHEK2 pathogenic variants have about a 2...
How do you contour the cauda equina for a lumbar spine SBRT case below the spinal cord?
I typically contour the cauda equina at the level of the upper lumbar spine just below the spinal cord based on T2-weighted MRI and utilize a 2 mm PRV. If the entire spinal canal is instead contoured just below the cord, this may lead to underdosing of the posterior aspect of the vertebral body.At t...