Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is moderately hypofractionated RT using 60 Gy/20fx with concurrent chemotherapy appropriate for unresectable stage III NSCLC?
No perfect answers, as usual. We (CALGB) did a prospective multi-institutional Phase I trial asking the question, what is the MTD for hypofx treatment with concurrent chemo for stage 3 disease? We came to an MTD of 60 Gy in 24 fx (2.5 gy/fx). Urbanic et al., PMID 29487024. Inclusion was your typical...
Given the PATRIOT trial and hypo-FLAME 2.0, do you consider once-a-week prostate SBRT instead of every other day?
Yes, it is reasonable to offer weekly prostate SBRT to patients.Quick review of evidence: hypo-FLAME 2.0 (De Cock et al., PMID 37178932) was a phase II single-arm trial that used 35 Gy/5 fx with FLAME-style isotoxic SIB up to 50 Gy/5 fx to visible tumor(s) with a bi-weekly schedule. N=124 participan...
Would you consider SBRT to a single nodal recurrence in a patient with previously treated metastatic GEJ adenocarcinoma s/p a complete response to systemic therapy followed by 37.5 Gy to the primary who was NED for 12 months up until this recurrence?
Tough case! I would consider reinitiation of systemic therapy at this time, given the relatively short interval since completion of prior RT as well as concern for short interval progression in other areas without systemic control. After ~4-6 months of systemic therapy, however, if no new sites of m...
Would you recommend hypofractionated PMRT with a positive deep margin?
I have used hypofractionated RT in this setting with final boost to area of positive margin equivalent to 60 Gy
How do you manage AEDs in patients with malignant brain tumors?
Use of prophylactic anti-seizure drugs in patients with primary malignant brain tumors is not recommended and has been evaluated in multiple systematic reviews and guidelines including a recent systematic review and well-done guideline paper from SNO and EANO published by Tobias Walbert, Elizabeth G...
Do you recommend post-mastectomy RT for a premenopausal woman with ER/PR+ Her2 negative breast cancer and Li-Fraumeni syndrome with RCBII and residual disease in multiple LNs following neoadjuvant chemotherapy?
I have been very reluctant to offer RT for patients with Li-Fraumeni syndrome as in limited published data, the risk of RT-induced second malignancy can be as high as 25%. Any potential benefit has to be weighed against the risk. In the above case, need to look at the entire clinical scenario and qu...
Would you offer radiation therapy for ovarian remnant syndrome?
I have treated a few times with mixed results to a dose of around 20 Gy.
Would you treat a patient with prostate biopsy (and or MRI) suspicious for extraprostatic extension as high risk if they otherwise have IR disease factors?
Men in the intermediate risk category are a heterogeneous group, and clinical factors can be a useful way to further stratify risk in this group. In our practice, because of an institutional outcomes study, we primarily use % positive cores > 50% as a means to select men for the more aggressive ther...
In patients receiving PMRT do you perform a boost if they have had reconstruction (tissue expanders,…)?
Ideally I think we should make treatment recommendations prioritizing the clinical features over the reconstructive approach. The benefit of the scar boost after mastectomy is unclear, and the target for the boost is also unclear, so I tend to reserve the boost for patients with multiple high risk f...
What dose and fractionation would you recommend for post-operative treatment of an isolated femur metastasis after surgical stabilization?
Interesting question.Traditionally, in Rad Onc, post operative RT after bone stabilization has been given to patients whom the operating surgeons deemed "appropriate". Some literature suggest only 28% to 50% of post-op patients are referred for post op EBRT.As such, because the data are so 'sketchy'...