Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In an elderly patient with limited transportation issues, is there a hypofractionated regimen you have found acceptable for a localized squamous cell carcinomas of the eyelid?
Assuming curative intent, treatment 55 Gy in 20 fx should do the job
For an non-operative patient with IB1 cervical cancer, would you recommend RT alone or concurrent chemoRT for definitive therapy?
I usually favor RT alone as local control and the outcome is excellent unless they have adenocarcinoma, a suspicious pelvic node, or multiple high risk features (high grade with LVSI on bx).
How do you approach treatment of a glioblastoma in pregnancy?
Glioblastoma during pregnancy could be treated safely (to mother and fetus) with certain precautions and modifications. Collaboration and consultation with the patient’s obstetrician are essential. External shielding over the patient’s abdomen during treatment will decrease the external scatter radi...
What factors do you consider when selecting dose/fractionation for whole brain radiotherapy?
I assume this question is for brain metastases patients who are not eligible for hippocampal avoidance WBRT (ineligible criteria including but not limited to - mets 5 mm within either hippocampus, germ cell/small cell/lymphoma, leptomeningeal disease, etc.) - my default WBRT dose fractionation is 30...
What is the recommended follow-up/surveillance schedule following organ preservation treatment approach for cT1-2N0 rectal cancer?
Patients with stage I rectal cancer treated with organ preservation require close surveillance to rule out tumor regrowth and local recurrence that may be salvaged with radical surgery. The highest risk of recurrence is within 2 years after completion of neoadjuvant therapy and patients should be fo...
Should hippocampal-avoidance WBRT be the default option for WBRT?
I think this is a difficult question to answer as a lot depends on the particulars. Here's a list of some of those issues: Radiosurgery is very easily administered & frequently free of toxicity. Systemic agents are showing improved efficacy in the brain. Surveillance MR imaging = lower incidence of ...
What is the optimal duration of ADT in high-risk prostate cancer treated with RT+ADT?
Nabib et al. presented "Final Results" of the 18 vs. 36 month ADT trial for high-risk M0 prostate cancer in Chicago during ASCO 2017. This trial has the potential to be practice changing, since most men receive 2+ years of ADT during RT-ADT for high-risk disease. 630 patients were randomized and OS ...
How long after achieving a CR would you consider stopping pembrolizumab in metastatic melanoma?
Based on Keynote 001 and more recently on Keynote 006, where we observed sustained remission in more than 90% of the patients who had stopped pembrolizumab for complete response, we usually consider stopping pembrolizumab in patients who have a confirmed complete response (this means that we have tw...
Is long term ADT now the standard of care with salvage prostate bed RT?
The dreaded hormone question...After 40 years of embarking on extremely well designed randomized trials, we still are confused about the who, what, when of ADT. Will RTOG 9601 create a new care standard? As @Dr. First Last said, I think we will see increased utilization. I have been using bicalutami...
Do you use either memantine or hippocampal sparing technique to preserve cognitive function when giving whole brain radiotherapy?
Dr. @Dr. First Last and I put together the response below:We use memantine and hippocampal sparing technique for all brain metastasis patients who are planning to receive WBRT. This is based off the recently published phase III trial NRG CC001 that found hippocampal avoidance WBRT plus memantine res...