Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the management of locally recurrent brain metastases that has undergone multiple resections and previous cavity SRS?
For local recurrence after prior SRS that we're convinced does not represent treatment effect, I consult with my neurosurgery colleagues regarding further surgical options including laser interstitial thermal therapy (which is typically preceded by biopsy). If surgical options don't exist, I general...
Would you offer lung SBRT to a medically inoperable patient with systemic lupus erythematosus or other connective tissue disorders if well controlled?
This is a very timely and clinically relevant question that had intrigued us for quite a while. Thus, we looked into our over 10 year experience at UCLA for 197 adult patients with collagen vascular disease. This work was recently published in JAMA Open Network: Yoon et al., PMID 33599771.The hypoth...
Is there a role for pre-operative RT (+/-chemo) for a borderline resectable Klatskin tumor as an attempt to try to get them to surgery?
From my perspective, there is a role for preoperative chemo-radiation for borderline resectable Klatskin tumors followed by re-evaluation for surgical resection (standard resection vs liver transplant). Neo-adjuvant chemo-radiation followed by liver transplant has been evaluated as a treatment opti...
When would you recommend adjuvant radiation following cystectomy for urothelial bladder cancer?
Local-regional recurrence for patients with ≥pT3 disease after radical cystectomy is a significant problem (1) and warrants consideration of adjuvant radiation therapy in patients who are likely to tolerate such treatment. Chemotherapy has not been shown to reduce the risk of local-regional recurr...
What SBRT dose and tissue constraints would you choose for a presacral rectal recurrence status post preoperative chemoradiation to 50.4 Gy followed by surgical resection in a patient who is not a candidate for surgical re-resection?
By first principes, irradiation should be given with lower doses per fraction, unless the recurrence is not near a critical structure such as bowel, ureter, periferal nerve or lumbosacrail plexus. Theses recurences are also multifical with nests of microscopic cells typically found in the surgical s...
How does RTOG 0815 change your recommendation for ST-ADT for men getting XRT for favorable intermediate risk prostate ca?
It is again a function of absolute risk and absolute and not relative benefit with ADT. Biomarker like decipher and artera helps quantify the absolute risk in this situation and guide in decision-making.
What volumes and prescription doses do you use when treating patients with unresectable cholangiocarcinoma?
Extrahepatic (EHC) and intrahepatic (IHC) cholangiocarcinoma are very different diseases. EHC tends to remain locoregional more often than IHC. Curative therapy must include surgery in general, but radiation has an important role, especially in patients with R+ resections. The data are not clear for...
Do you use any drugs prophylactically to reduce the risk of radiation pneumonitis in lung SBRT?
I have not although there are varying levels of evidence to support each of these agents. I think it points to a broader failure as a field to develop radioprotective strategies that could enhance our therapeutic ratio. RTOG 0123 made an attempt at a prospective evaluation of captopril to reduce rad...
Does the presence of multiple positive intramammary lymph nodes in the setting of negative sentinel lymph nodes cause you to treat regional lymphatics?
In the non-sentinel node era, all these patients had axillary dissection and had higher likelihood of the axilla being positive. In the era of sentinel node biopsy, we usually we don't change if sentinel node was mapped and sampled successfully. The thought process is for these patients is that the ...
What dose-fractionation regimen do you prefer when treating with hypofractionated whole breast radiation therapy without a boost for early stage breast cancer?
I typically use the Canadian fractionation, and boost patients who are young (<50), high grade, triple negative, or Her2+.