Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When do you recommend preop RT for retroperitoneal sarcomas?
I imagine I'm not alone in feeling a tad frustrated with the STRASS trial results, not because of the negative primary endpoint in regards to radiotherapy, but because it failed to clearly answer the question it was supposed to.In brief, the STRASS trial was a 2-arm randomized controlled trial of su...
Would you offer adjuvant radiation therapy in a young adult with NF1 who has a craniopharyngioma s/p STR?
In NF1 patients, radiation therapy for craniopharyngioma has been associated with vascular damage and Moya Moya syndrome. On the other hand, subtotally resected craniopharyngiomas have a high chance of recurrence. It has been shown that, dosimetrically, intensity-modulated proton therapy (IMPT) coul...
How do you incorporate absolute percent pattern 4 (APP4) into your risk stratification, specifically your recommendation for ADT for intermediate prostate cancer?
Summary: The short answer is that APP4 is unlikely to improve risk prognostication to the extent to which other advanced biomarkers (GC, MMAI, etc.) do. It is also unlikely either alone or in combination with standard clinical factors to serve as a predictive biomarker. Nevertheless, it is certainly...
Do you treat inguinal lymph nodes for rectal cancers involving the anal canal?
One of my residents recently told me that I should treat the inguinal nodes for low lying rectal cancers based on recommendations on the MedNet. I realized this is an old post, but I would like to add a nice reference that really convinced me that there is probably minimal benefit to treating inguin...
Should the use of a brachytherapy boost affect the duration or use of ADT in intermediate or high risk prostate cancer?
We traditionally think of 4-6 mo ADT for intermediate risk, and 18-36 mo ADT for high risk men treated with EBRT (whether dose escalated or not). For high risk men in our practice, I have usually recommended 28 mo (from RTOG 9202) ADT as a standard. I do think it is fair to consider a course <28 mo ...
What prostate cancer patient population would benefit from a brachytherapy boost after EBRT without the use of ADT?
The paper referenced in the question for better or worse is the best evidence we have regarding the benefit we can expect from a brachy boost, the benefit we can expect from the addition of ADT to EBRT, and if you were to compare EBRT+ADT vs EBRT+brachy. It shows that adding ADT has an OS benefit co...
For a patient with a rising PSA after prostatectomy with seminal vesicles being negative for disease at surgery, do you ever treat the prostate bed and seminal vesicle bed with different doses in an SIB plan?
Conclusion: The short answer is no, I do not utilize de-escalation to the SV bed, and I treat the entire operative bed to 64-66.6Gy. Below is a rationale and some linked resources, if helpful: A. Dose: The recently published RTOG 0534 allowed a range of doses (64.8Gy-70.2 Gy); however, since the ini...
Do you offer liver SBRT for metastatic colorectal cancer after local recurrence following previous treatments such as radiofrequency ablation (RFA), radioembolization, and chemoembolization?
I do offer liver SBRT for local recurrence after other liver directed therapies. With regard to RFA, there have been a number of single institution retrospective studies suggesting that RFA has a higher recurrence rate than SBRT for lesions larger than 2-3 cm (Jackson et al., IJROBP 2018; Franzese e...
Do you advise patients to hold DMARDs for conditions such as psoriasis or rheumatoid arthritis while actively undergoing radiation treatment?
Data in this setting is limited. I have usually not held DMARDs with RT unless treating with concurrent chemo RT or treating a site (pelvis) where myelosuppression caused by RT would further suppression immunity especially with biologics and methotrexate.
How do you approach anti-seizure medication management when it was started by another team for a seizure-naive patient before/after craniotomy for a tumor?
I would refer you to Dr. @Dr. First Last's answer to a similar question (https://www.themednet.org/question/15031) which beautifully summarizes data and guidelines. I usually counsel patients that everyone regardless of their medical history has a certain risk of seizure under physical stressors, th...