Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What dose-fractionation would you utilize to treat an oligometastatic rib lesion for durable local control?
Generally speaking - I tend to favor 35/5# for rib metastases, but as is the case with any oligometastasis scenario and SABR scenario the devil is in the details. Things to consider - 1. Why is the lesion being treated, is it a solitary met? If so, could consider a higher dose like 40/5 with the ai...
When do you offer radioembolization (Y90) in the treatment of unresectable HCC?
Y90 does have some more data of better LC than TACE but not with OS in the Brown meta analysis (Brown et al., PMID 35943116). I think for small tumors less than 5 cm, Y90 can be appropriate. I would not treat it for PVTT. The SARAH trial had a large majority with PVTT and was negative. As were Sorem...
What are your top takeaways from ASCO GI 2023?
Top 3 radiation oncology studies: Abstract 489- NRG/RTOG 1112 presented at ASTRO but only phase III study to establish the role of liver SBRT in HCC; will SBRT supplant radioembolization given the 3 negative phase III studies for radioembolization in contrast to this positive study for SBRT Abstract...
Would you offer adjuvant chemoRT for node positive high rectal cancer above the peritoneal reflection?
I would not offer RT to this patient. If you look at the data, the risk of local recurrence of rectal cancer decreases dramatically as the distance from the anal verge increases, and with proper surgery, is well under 5% (probably 1-2%) for tumors above 10 cm. It is not even clear that the tumor des...
Will you consider definitive concurrent chemoradiation for stage IV lung adenocarcinoma with metastasis limited to an internal mammary lymph node?
I'd certainly consider it upfront if lung and cardiac constraints can be reasonably met. There have been a few small series now demonstrating good outcomes in patients who received definitive chemoradiation to thoracic disease in the setting of limited metastatic disease. Generally, I would favor an...
Can APBI be integrated with oncoplastics?
If patients are having oncoplastic surgery, I typically do not offer PBI due to concerns about appropriately identifying cavity, particularly in situations of tissue rearrangement. I have offered to patients with reduction mammoplasty and a UOQ cavity where the cavity is intact with seroma and clip...
What is the optimal treatment for adenocarcinoma of the vulva?
I don’t know what is optimal but usually, they are associated with Paget's disease or Bartholin gland tumor and we follow the surgical principle same as SCC followed by adjuvant RT as indicated based on margin or nodal status.
How do you deal with the brachial plexus in head and neck cancer radiation (ie suprglottic larynx) when there is a positive node near the plexus or when you have an involved nodal level that you want to take to a higher dose?
I treat the cancer to full dose. If the patient is suitable for a neck dissection you could possibly give 60 Gy and plan to add a neck dissection. However, if treating gross disease or positive margins, go to 70 Gy.
For what duration should abiraterone be used in a patient with biochemical and pelvic node recurrence (N1M0) who had prior definitive therapy with either RP or RT?
This is a similar but slightly different question than the one answered by Attard et al., PMID 34953525. This meta-analysis of randomized trials demonstrated a survival benefit with the addition of 2 years of Abiraterone + ADT compared to ADT in men who received definitive management for N1 prostate...
Would you use abiraterone or docetaxel in addition to ADT and radiotherapy for patients with very high risk, node-negative prostate cancer?
The most recent update from STAMPEDE's abiraterone arm in the M0 N0 very high risk setting was reported here: Attard et al., PMID 34953525 and strongly suggests that abi/ADT for 2 years plus radiation improves MFS and OS significantly and should be standard of care for men who are choosing RT in thi...