Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is it acceptable to give weekly cisplatin for patients with locally advanced head and neck SCC undergoing chemoradiation?
@Dr. First Last just presented at the ASCO H&N highlights session that weekly cisplatin 40mg/m2 is now considered a standard of care, at least in the post-op high risk setting based on data by Dr. Kiyota et al. showing superior outcomes, likely due to higher cumulative cisplatin dose (>200mg/m2) com...
In light of the recent data indicating increased late grade 3 to 5 toxicities (LTOX3) after hypofractionated salvage radiation therapy, will you continue to offer these regimes to patients?
Prior Literature: Prior non-randomized studies seem to suggest excess toxicity with hypofractionated PORT (e.g., Cozzarini et al., PMID 24985964, Tandberg et al., PMID 29559284). In part for this reason, a phase III, randomized controlled non-inferiority trial, NRG-GU003, was conducted (Buyyounouski...
Would you recommend discontinuing testosterone replacement in a male patient in his 60s with newly diagnosed favorable intermediate-risk prostate cancer who is declining surgery and will receive definitive radiation?
Historically, we (as a field) have viewed TRT as the opposite of ADT and therefore inherently problematic. I am not convinced this is logical. ADT has RCT evidence to support it, whereas withdrawing TRT has not been as cleanly studied. Let's say we stop TRT, and this drops their testosterone to 150 ...
How would you treat a young man with a history of stage IA testicular pure seminoma s/p radical orchiectomy who has a solitary left inguinal lymph node recurrence and normal tumor markers?
Relapse in an inguinal node is somewhat unusual in testicular cancer unless there has been prior scrotal violation or surgery for maldescent. Trans-scrotal biopsy of the testis is usually an incorrect approach, as it can cause a different pattern of spread (to the inguinal nodes). Thus, I would not ...
For a patient with glioblastoma also found to have a distant presumed meningioma with a location/size such that you would have otherwise recommended RT, would you offer concurrent treatment?
I think if the situation is non-urgent and the lesion (meningioma) can be safely monitored, one approach would be to prioritize treatment of the glioblastoma while observing the meningioma. If, however, the meningioma demonstrates interval growth and/or is located in an area at higher risk for causi...
When do you refer patients back to their PCP for the predominant management of their medical care following completion of oncologic or BMT treatment?
Transitions of care are always challenging, especially for patients with complex medical histories, including cancer or stem cell transplantation. There are many different models for how and when to transition patients back to primary care or shared care. The ongoing, often complex needs of survivor...
Would you offer adjuvant radiation to a large solitary fibrous tumor of the lung s/p wedge resection with close margins?
If a benign SFT, I'd observe. If malignant, I'd consider 50 Gy/25 fractions to the surgical bed. The role of adjuvant radiation isn't well established, with some small reports suggesting LC benefit with tumors >5 cm and/or positive margins. Given "large" and more limited surgical resection with wedg...
How should you manage a coronavirus infected/suspected patient who is receiving radiotherapy and cannot interrupt or delay their cancer treatment?
Hi Everyone, I agree with all the comments—this is certainly a fluid situation. We have not had a confirmed COVID-19 case, but we have developed a plan. If it is deemed a known COVID-19 patient, and it is elected to continue treatment by the treating physician, the treatment will happen at the end o...
Given the 10-year outcomes of UK FAST-Forward presented at ESTRO, how have you expanded the use of ultra-hypofractionation in your practice?
We offer 5 fractions to all early-stage breast cancer patients. If technically suitable, the preferred option is APBI; otherwise, FAST-Forward 26 Gy in 5, ensuring dose homogeneity as specified in the protocol.
How do you approach the discussion about the potential risks of radiation therapy exposure and the development of secondary malignancies for patients with germline BRCA1/2 mutations?
It appears that the risk of secondary malignancies due to radiation exposure does not seem significantly enhanced in gBRCA-m carriers, unlike patients with Li-Fraumeni syndrome (for whom we would attempt to avoid radiation). The data on mBRCA-associated breast cancers would suggest that radiation is...