Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In what situations would you treat elective regional lymph nodes for a squamous cell carcinoma of the skin on the extremity/trunk that was clinically node negative?
Nodal metastasis from small, to medium size [up to 3 cm in diameter] squamous cell carcinoma on the extremity is not that common. Considering the morbidity of nodal treatment in a patient with clear margins of resection I would not prophylactically treat the nodes. If the tumor shows perineural or l...
What volume and dose would you use for a Stage I MALT lymphoma of the lung?
MALT lymphomas are highly radiosensitive. Curative standard doses are 24 Gy in 12 fractions and 30 Gy in 20 fractions. The latter and slower dose fractionation (30 Gy in 20) is best used specifically in the setting of stage IAE Gastric MALT - a unique site with significant risk of radiation induced ...
Would you consider adding abiraterone to ADT and salvage RT in a prostate cancer patient with pN1 disease at radical prostatectomy?
This is a question that is being addressed in the salvage setting by NRG GU008. Currently, we have high level evidence that adding abiraterone to ADT is superior to ADT alone for subsets of patients with metastatic disease and the combination with RT is superior to ADT alone plus RT for both clinica...
When recommending salvage RT post-prostatectomy for an ultra-sensitive PSA level <0.1, do you still recommend concurrent hormonal therapy?
There is potentially an interaction between ADT's benefit and the PSA at the time of treatment. This was most well delineated in RTOG 9601 (Dess et al., PMID 32215583), but since then, using modern LHRH agonists, that interaction has been less well established (GETUG-AFU16, SPPORT, and RADICALS-HD)....
Do you ever dose escalate radiotherapy to the primary in low volume metastatic prostate cancer?
Background: STAMPEDE Arm H (SOC ± RT to prostate) allowed for two fractionation schedules, 55 Gy in 20 daily fractions (67 Gy EQD2[α/β = 1.5]) and 36 Gy in 6 weekly fractions (77 Gy EQD2[α/β = 1.5]), without correction for treatment duration), and approximately half of participants received each sch...
Do you prescribe prophylactic steroids to patients receiving radiosurgery for AVMs?
I do not use prophylactic steroids when treating AVMs with stereotactic radiosurgery. In fact, usually SRS of AVMs is rarely associated with edema and these patients rarely require steroids in the observation period after SRS.
In patients with low grade gliomas that are older than 40 y/o or have subtotal resections, do you ever withhold upfront RT off protocol?
Yes. We should be humble about the data supporting RT in this scenario (that is, for IDH-mutant tumors). I would suggest that for IDH wild-type tumors (i.e., molecular GBMs) RCTs in the '70s established an OS benefit for RT and that withholding of RT is not supported.For IDH-mutant tumors, data from...
Do you constrain heterogeneity or hotspots when delivering spine SBRT for bone metastases?
We treat bone and spine mets "SRS" style which means accepting high hot spots (130%) within the GTV to allow for steeper dose fall offs just outside the target and hence lower normal tissue doses...
How do you approach a patient with stage IIA non-small cell lung cancer who received SBRT?
Well, this is a very challenging question that certainly has come up in discussions at times over the years and I could conclude with a very simple answer: No or could offer a more twisted answer arriving at the same response- just for the fun of it, let’s do the latter.So how would we, as a multidi...
Would you offer immunotherapy after chemoradiotherapy for Stage III lung cancer given results of PACIFIC Trial?
In light of the comments by Professor Vansteenkinste comparing the ESMO 2017 plenary session incorporating the PACIFIC study results as a “tsunami” in the footsteps of last year’s ESMO lung cancer “earthquake” presentations, an appropriate title to this question might be- should we let the” floodgat...