Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is TURP a contraindication for prostate cancer SBRT?
I have not done it, but Georgetown experience recently published here: Pepin et al., PMID 32432033A recent informal Twitter poll shows many are comfortable with SBRT after TURBT: https://twitter.com/TylerSbrt/status/1323315130990432256?s=20I'm interested if any have further insight.
How would you counsel a young female patient who refuses to use contraception during radiotherapy?
A woman who refuses contraception needs careful psychological and psychiatric assessment and considerable time at the time of consultation to understand why she is refusing, especially since this response is neither rational nor logical. The practitioner needs to take the time to discuss the patient...
Would you consider APBI in an otherwise-suitable patient who has ITC in a sentinel lymph node?
I would treat ITC like node negative and would treat with APBI if otherwise suitable.
Would you offer preoperative radiation for an intrathoracic leiomyosarcoma in the posterior mediastinum?
I would want further details (age, grade, size, specific anatomic relationships, etc), but most likely yes. DOSE AND FIELD: I would typically treat GTV + 1.5 cm anatomically constrained expansion to 50.4/28, plus any suspicious edema on T2 STIR. By analogy with retroperitoneal sarcomas, I think one ...
For patients with Stage IIIB or IV HD flowing Bv-AVEPC with initial large mediastinal adenopathy, how can we avoid ISRT?
It is true that on the clinical trial AHOD1331, patients who presented with large mediastinal adenopathy received radiation therapy as did patients who were slow early responders (Deauville 4 or 5 after two cycles of therapy). It is noteworthy that 3-year event-free survival was extremely high for a...
What are your top takeaways in GU Cancers from ASTRO 2024?
The Presidential Symposium was outstanding. Dr. Brandon Mahal’s presentation hit on a top priority for the field, in my view: how do we improve/accelerate the implementation of advances like focal microboost for prostate cancer? RCT evidence of benefit to dose escalation is rare in rad onc. The FLA...
What are your top takeaways in Thoracic Cancers from ASTRO 2024?
1. Concurrent Chemoradiation ± Atezolizumab (atezo) in Limited-Stage Small Cell Lung Cancer (LS-SCLC): Results of NRG Oncology/Alliance LU005 published in issue: October 01, 2024 S2 Although disappointing, the negative results of this trial reinforce that there is no benefit to concurrent immunother...
How do you sequence Ra-223 and Lu-177 in patients with mCRPC with predominantly bony disease?
The RALU study (Rahbar et al., PMID 36302656) really is quite a small 49-patient cohort study looking at the one-way question of the safety of PSMA-Lu177 in carefully selected patients who had adequate marrow function after both an ARSI, taxane chemo, and radium-223. While these selected patients to...
Would you consider omitting adjuvant radiation in a very elderly patient with a small triple negative breast cancer?
Elderly isn't quantitative or qualitative. Would want to know performance status/life expectancy.Occasionally, patients have had enough and they don't want further treatment after surgery.I presume they also will not receive chemotherapy. If breast cancer takes her life, it will be because of distan...
Which patients, if any, treated according to PROSPECT for an early stage rectal cancer, would you offer surveillance if they achieved cCR after neoadjuvant chemotherapy?
Thanks for the important question. This is a nice but also challenging situation given, at this time, we do not have evidence for organ preservation with chemotherapy alone. Nonetheless, the PROSPECT trial did show approximately 20% of patients indeed achieved pathological compete response (was quit...