Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Have the breast surgeons at your institution adopted the SOUND trial into their clinical practice?
Not at our institution with this practice still being limited to 70 and above.
When do you consider lymphadenectomy vs pelvic lymph node RT in a lymph node recurrence after prior prostatectomy or prostate-only RT?
I typically recommend a modified GETUG P07 (OLIGOPELVIS) treatment paradigm in this setting because I believe it has a favorable toxicity and short term treatment efficacy as well as the best evidence basis at this time. This regimen consists of a fractionated, extended pelvic nodal field with conco...
When would you opt to manage anal squamous cell carcinoma, HPV+ with surveillance vs adjuvant treatment following a trans-anal excision?
Never
How would you manage adjuvant therapy for a patient with pulmonary adenoid cystic carcinoma s/p resection with positive bronchial and vascular margins and nodal involvement?
Manage with adjuvant radiation. No role for systemic therapy concurrently or in adjuvant.
Do you recommend an additional procedure for melanomas if there is tumor within 1-2mm of the margin?
My understanding has been that a re-excision of melanoma is based on initial Breslow depth. As long as the margins are clear on that re-excision, regardless of being 1-2 mm away from any one edge, there is no indication for additional surgery.
Would you offer focal prostate boost per FLAME protocol for GTV defined by PET alone without MRI?
I think there are two questions here: Can you use PSMA PET to define the boost target? Yes (with a little bit of caution). There have been several reports on the safety/feasibility of PSMA-based focal boost. Note, though, that FLAME was based on MRI, and we can expect that the PET-defined lesion may...
For patients with primary CNS lymphoma and less than a CR to chemotherapy, in what situation would you consider partial or focal radiation?
For the sake of discussion, I will assume that this patient achieved a PR after a high-dose MTX regimen. If the patient is young (<60 yo) and has a good KPS (>70), I would consider using a reduced dose of WBRT (30-36) followed by a boost to the residual lesion to an equivalent dose of 45 Gy (either ...
How would you treat a synchronous low rectal adenocarcinoma and anal squamous cell carcinoma with involved pelvic and inguinal nodes?
If the patient has intact bowel/anal sphincter function at baseline, I’d favor an organ-preserving approach. I’d treat with standard pelvic + inguinal chemoradiation with a dose/fractionation scheme isoeffective with 45 Gy in 25 fractions targeting pelvis/inguinals and a dose isoeffective with 54-56...
What are your top takeaways from ASCO GU 2024?
Prostate. BRCAAway. This small but important phase 2 randomized multicenter trial of HRRm mCRPC in the first line setting demonstrated the clear synergy in delaying progression or death and inducing better response between abiraterone and olaparib as compared to either abi or olaparib monotherapy o...
For recurrent glioblastoma treated with combined re-irradiation and bevacizumab, how long do you continue bevacizumab?
In the event of recurrent GBM, for example, if i.e. fSRT regimen like 30 Gy/5fx to be used for salvage, would not exceed more than 12 doses (6 cycles) of bevacizumab max. Even in the pseudo-response setting, the toxicity far outweighs the benefit beyond this.