Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
As PARTIQoL was a negative study, what is the current role for proton therapy in the management of prostate cancer patients?
Thank you for the comprehensive answer Dr. @Dr. First Last! It is interesting you talk about integral dose - that almost rarely comes up from the patient in my experience. They have read and have been told that it IS less toxic (not that it may be). They are told that protons are better and the auth...
How would you treat a oligometastatic para-aortic recurrence 1 year after definitive chemo-radiation for anal cancer?
We have successfully treated several patients with either synchronous or metachronous paraaortic nodal mets from anal SCCA with definitive dose chemoradiation. If not in a previously irradiated field- we give 50-58Gy in 25-29 fractions with concurrent cis and 5FU depending on the size of the node an...
What would you recommend for a patient with a new or locally recurrent anal cancer s/p chemoRT for anal cancer 15 years ago?
I would never irradiate a local recurrence of anal cancer for several reasons. The anal canal is a sensitive structure and the consequence of radiation injury is severe (ulceration, pain, bleeding). We could only give 39Gy in 26# BID or maybe 45Gy in 30#BID with two agent chemo. The cumulative dose ...
How do you manage palliative pelvic radiotherapy in a patient receiving Avastin?
Great question. Using Avastin with concurrent pelvic radiotherapy? The matter of serious adverse events led to an FDA ruling against its use concurrently with radiotherapy in 2007. The issues of thromboembolic events, bleeding, and fistula formation are a real thing with this drug and radiotherapy ...
How would you manage incidentally-found prostate cancer on TURP?
The patient's risk group along with genomic classification with Decipher would inform the treatment recommendation regardless of the source of the tissue. The pathologist should be able to estimate how much of the tissue had cancer and provide the Gleason Group. The location and volume of tissue are...
Would you recommend definitive XRT for prostate cancer in patients with prior Holmium Laser Enucleation of the Prostate (HoLEP)?
There are multiple options for outlet procedures in patients who present with baseline obstructive symptoms but prefer to avoid a radical prostatectomy. HoLEP is an effective procedure preferred by some urologists due to low re-treatment rates. HoLEP can often be quite aggressive leading to marked r...
How would you approach a patient with early-stage orbital MALT lymphoma with high proliferative index?
Local control for indolent lymphoma with 2 x 2 Gy is very good based on this series. Fasola et al., PMID 23726002. I am in favor of attempting 2 x 2 Gy and closely monitoring (together with an ophthalmologist) for possible recurrence, which can then be treated with full-dose RT (24-30Gy). This appro...
If using 26-fraction moderate hypofractionation, what dose do you use for the intraprostatic dominant nodule SIB?
The definition of a nominal prescription dose for a focal boost is a confusing topic as often times the coverage at a given prescription dose is outside the realm of what is usually considered a valid prescription dose (i.e., coverage at a requested prescription dose is < 95%), and a prior thread al...
Is there any evidence that ivermectin suppresses the PSA level in prostate cancer?
Is this even the right question, though? ADT drops PSA very reliably and yet does not cure patients. Finasteride suppresses PSA, but we do not use it as a mainstay of cancer treatment. Even if ivermectin *did* suppress PSA, unless there is a meaningful oncologic benefit (*at least* reduced recurrenc...
Would you have a patient temporarily discontinue methotrexate while receiving a FAST or FAST FORWARD regimen for breast irradiation?
I favor continuing as the dose of MTX is low for RA and in CMF era with much higher methotrexate dose, RT plus MTX was well tolerated.