Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you treat the prostate alone, or prostate and mets in an oligometastatic prostate cancer patient?
It's a good question and we are tempted to answer "prostate and mets" as the literature is building up, but we are still waiting for randomized phase III trials. The evidence so far suggests that stereotactic ablative radiotherapy (SABR) is promising. SABR-COMET trial has shown an improved OS for SA...
How do you approach rising PSA many years after prostatectomy with negative PSMA PET?
The devil is in the details. What is the status of the patient? In other words, what is the expected survival of the patient given his age, performance status, and medical conditions? There are online calculators that can be used to help. At what PSA value was the PSMA scan obtained? The utility of ...
Is there data to support worse surgical outcomes in short course RT followed by surgery vs. long course chemoradiation followed by surgery in rectal cancer?
This question seems to be asking about surgical outcomes between short and long course radiation in both TNT and non-TNT approaches. With regards to the latter, the TROG 01.04 trial compared pre-operative short course RT to long course chemoRT. There was no difference in OS, LC, late toxicity, or su...
How do you treat locally recurrent papillary thyroid carcinoma following multiple surgeries/RAI?
This is a good question and fortunately depicts a clinical case we don't often see. Obviously as a surgical disease, the surgeon really needs to totally sign off on this case before stepping in with XRT. In this era with newer TKIs we often have the patient see the med oncol or endocrinologist with ...
Would you treat a uterine carcinosarcoma with omental spread with adjuvant whole abdominal radiation?
I would not offer any external beam irradiation for this patient. Even isolated omental spread in uterine carcinosarcoma represents metastatic disease. Thus, they only reasonable option is chemotherapy, usually systemic agents such as carboplatin and paclitaxel or cisplatin and ifosfamide.
For an otherwise resectable esophageal cancer with involved celiac lymph nodes, would you ever consider an SIB beyond 50.4 Gy?
Intuitively, it seems like 50.4 Gy is not enough, as pathologic complete response rates are low. Based on multiple randomized trials, no dose higher than 50.4 Gy has been superior to 50.4 Gy for esophageal cancer. This included the primary tumor and grossly involved nodes. The NCCN now recommends st...
For NSCLC patients who are polymetastatic who then become and remain oligometastatic, is there a role for local ablative RT to the primary and metastatic sites?
I think it's an evolving area. I've had several patients with metastatic NSCLC where all their disease except for a couple of spots resolved on subsequent pet scans, for example. The med oncs ask if we could treat those, and I generally will on the theory that these sites might have a different biol...
What are your top takeaways from ASTRO 2023?
1. LBA 05: Wong JS, et al. Patient-reported and toxicity results from the FABREC study: a multicenter randomized trial of hypofractionated vs. conventionally fractionated postmastectomy radiation therapy after implant-based reconstruction. This is the first report of one of the two trials in North A...
For a young patient with advanced TNBC with a single lung nodule status post NAC, not amenable to biopsy, would you consider SBRT to the lesion?
Look for prior imaging (they’re young so may not have prior chest imaging with any significant lead time to draw any conclusions). In the absence of any evidence of other sites of disease and no history of evolution of that nodule, I’d move forward with the completion of appropriate adjuvant therapy...
How would you manage a borderline resectable pancreatic cancer s/p induction chemo + chemo-RT who was unable to go to surgery?
Tough situation. If there was stable/slight progression of disease at 6 months, I would not be inclined to offer reirradiation at that time. If any possibility of radiographic stability, tumor markers were stable, and the patient was clinically well, I would continue with close surveillance. If clea...