Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How often do you believe para-aortic radiotherapy in addition to pelvic radiotherapy causes additional treatment breaks due to acute toxicity?
I would agree with @Dr. First Last that with IMRT and accurate definition of targets and organs at risk, that treatment can be delivered successfully. In patients who have had prior chemotherapy, attention to weekly blood counts is imperative. It is usually the platelet counts that pose a challenge....
What are your treatment volumes for patients with gastric cancer receiving adjuvant chemoRT for a positive margin following gastrectomy and D2 nodal dissection?
INT-0116 remains the only positive phase III trial showing a benefit to adjuvant chemoradiation for gastric cancer. Though very few of those patients had D2 dissections, unplanned subset analyses of 0116 and comparison to a contemporaneous Korean non-randomized trial in patients with D2 dissections ...
How do you approach pre-operative chemoradiation for vulvar cancer?
Over time, the approach shifted from administering preoperative doses to delivering more doses in the mid-60s. Biopsies are now conducted at 8-12 weeks for persistent abnormalities to define pCR and persistent disease, thus enabling tailored management (Richman et al., PMID 32981696).Also this abstr...
In light of findings from GOG 258, is the benefit of adjuvant RT in IIIC endometrial cancer worth the potential acute and late risks of RT in the setting of significant autoimmune disease?
I agree with the thoughtful answers of others in terms of tailoring therapy and balancing risk/benefit. In this case, however, GOG 258 answered the value of doing radiation on top of chemotherapy for any patient that met its criteria. And in this case, it included 75% that indeed had stage IIIC dise...
Would you recommend adjuvant neck radiation for metastatic chordoma to cervical lymph node, s/p neck dissection, with 1/10 positive nodes and no residual on post op imaging?
Yes
How do you counsel patients and partners of patients with HPV+ cancers regarding the HPV vaccine?
The patient was likely exposed in their teens or twenties. The partner is likely too old to be vaccinated. Independent of the cancer, children should be vaccinated.
Has the recent presentation of RADICALS-HD changed your ADT duration recommendations for patients receiving post operative radiation therapy for prostate cancer after radical prostatectomy?
The way I interpret RADICALS is that for adverse pathology meaning GS 8 and above, T3 disease or node positive who benefit from ADT would favor 24 over 6 months and probably these are patients who benefit from nodal RT also. For a favorable type prostate fossa only RT with unclear if any additional ...
What percentage of your patients receive hydrogel SpaceOAR?
T3+ or poor KPS, we don't use SpaceOAR.
Do you ever consider small vessel doses when determining your dose for SBRT?
We do not constraint dose to the azygous vein, or other small vessels when giving SBRT. We similarly do not constrain dose to large vessels such as the IVC or the Aorta either, and I am un-aware of specific reports of toxicity to these structures. Structures that I am particularly concerned about ar...
Should combined brachytherapy/EBRT/ADT be the standard of care for men with high-risk prostate cancer?
The results of the ASCENDE-RT trial are obviously very encouraging and corroborate findings from single institution studies that combined brachytherapy and external beam radiotherapy in conjunction with hormonal therapy is associated with superior outcomes compared to dose escalated external beam ra...