Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What are your top takeaways from SABCS 2023?
The B51 trial surprised the radiation oncology community, showing that in patients with an exceptional response to systemic therapy, radiation to the regional nodes did not result in a significant improvement in the invasive breast cancer recurrence free interval nor the isolated loco-regional recu...
Would you offer hypofractionation to a patient in the salvage/adjuvant post-prostatectomy setting outside of a clinical trial?
No unless operating in a resource-scarce environment. My colleagues and I have been using 2.5 Gy for almost a decade at the Durham VA. The results have been recently published.NRG trial (GU003-Mark Buyyounouski PI) comparing 66.6/1.8 Gy to 62.5/2.5 Gy has been accruing very quickly and will close ve...
Given the findings of SUNSET, demonstrating 60 Gy in 8 fractions to be a safe and effective regimen for ultracentral lesions, in what situations would you elect to use a 10 fraction hypofractionated regimen?
Style point, I'd say. Both are pretty similar biologically. Those with some Houston in their academic genes are probably more likely to use the 10 Fx regimen (my personal choice for ultracentral), but I think 60/8 is an excellent option.
What are your top takeaways in Breast Cancer from ESMO 2024?
The most interesting and impactful paper was LBA18 – DESTINY-Breast12 showing significant responses in HER2+ brain metastases – including untreated brain metastases. The median PFS and survivals were truly impressive Abstract 3400, testing patritumab (HER3-targeting antibody-drug conjugate) in a Pha...
When using hyperfractionation with a BID regimen, what are typical dose constraints for the head and neck?
Similar to 2 Gy once daily with a little more wiggle room
Would you treat an in-field recurrence/marginal recurrence of NSCLC following previous definitive chemoradiation with salvage SBRT?
I would layer the answer to the patient. First question: Local control, yes or no. If yes, then when... to answer that discussion of systemic option and timing in multiD eval. If yes, then how... surgery, IR thermal ablation, radiation. If radiation then dose/technique... 50 Gy 5 fx, 50 Gy 10 fx, 50...
Do you stop consolidative durvalumab after one year as per the PACIFIC trial or continue if the patient is otherwise tolerating well?
The purpose of definitive therapy with chemoradiation followed by durvalumab is cure. The overall survival was significantly improved in those who received durvalumab for a year in the PACIFIC study. The follow up remains immature, but this data suggests that more patients with stage III lung cancer...
Is there evidence that radiotherapy to less than all sites of oligometastatic prostate cancer is beneficial?
The ORIOLE trial referenced above helps to answer this question. Within the SBRT arm (n=36), patients received PSMA PET, however, the treating rad oncs were blinded to the result and patients were "consolidated" based on conventional imaging. Treatment plans were then reviewed and compared to PSMA, ...
How would you treat an axillary presentation of a breast cancer in the absence of a breast primary?
In the era of MRI these have become rare as sensitivity of MRI is high. Our approach is to treat breast and RNI with no mastectomy as reported LR is low with this approach
What are the advantages/disadvantages of using static IMRT vs VMAT when treating breast cancer?
I think like most disease sites, you gain conformity and possibly more homogenous dose, while the low-dose bath increases. For PBI, I strongly prefer VMAT rather than mini-tangents with FIF (a type of IMRT). I have not found tangential inverse-planned RT to be beneficial in these cases. The VMAT pl...