Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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...
What strategies do you use for dose escalation when irradiating patients with inflammatory breast cancer?
I usually treat with conventional 2Gy to 25 fractions followed by 10 gy boost to scar area. In patients with a poor response to chemo, consider increasing the boost to 16 Gy. If they have any prechemo nodes like IM node or supraclav nodes, then boost the involoved node to higher total dose of 56 to ...
For patients with triple negative breast cancer who are planned to receive adjuvant pembrolizumab, would you recommend pembrolizumab be held until radiation is complete?
This will become a practical issue for radiation oncologists as four drugs are now approved for adjuvant treatment after neoadjuvant chemotherapy including pembro, xeloda, T-DM1, and olaparib. Out of these, olaparib and xeloda were done sequential after radiation as concern about increased side effe...
How do you treat synchronous rectal cancer and prostate cancer?
There are several case reports describing the treatment of localized synchronous prostate and rectal cancer. Combined radical retropubic prostatectomy and rectal resection has been described but is associated with high morbidity (Klee et al.). Definitive external beam chemoradiation therapy with 5-F...
What fractionation and dose constraints do you use for prostate SBRT?
UCLA King Protocol8 Gy x5PTV 95% of PTV volume to get 95-110% rx doseRectum V50 (20 Gy) < 50%V80 (32 Gy) < 20%V90 (36 Gy) < 10 %V100 (40Gy) < 5%BladderV50 (20 Gy) < 40%V100 (40 Gy) < 1.1%Femurs V40 (16 Gy) < 5%Small Bowel V50 (20Gy) < 1%
How would you manage a radiation induced sarcoma of the spinal cord following R1 resection?
Sarcomas, whether radiation-induced or spontaneous, require doses in excess of 60 Gy to control following R1 resection. In this case, the challenge is also associated with the fact that this area of the spinal cord was treated 40 years earlier with presumably cord tolerance doses for an ependymoma. ...
What volumes would you cover in a young patient with otherwise low risk breast cancer in whom the sentinel node failed to map and ALND was not performed?
I would favor high tangent including levels 1 and 2 in the field.
Would you offer SBRT in a patient with history of CRC, subsequently found to have a solitary liver metastasis treated with chemotherapy followed metastasectomy with positive margins?
This is a difficult scenario, as there is little data to guide whether we should be radiating adjuvantly post metastectomy. My answer to this question would be, it depends. The rationale for offering adjuvant radiation in the setting of an R1 hepatic metastatectomy is based on multiple studies that ...
Is there a maximum time delay in offering adjuvant radiation to patients with wound healing issues for sarcoma and skin cancer patients with aggressive histology and positive margins?
A recent large NCDB review of 35,000 patients with resected nonmetastatic HNC who underwent postop RT found that the interval from surgery to the end of RT was a significant factor in overall survival, with interval of 11 weeks or less conferring best survival compared with longer intervals, especia...
Would you consider palliative RT in the setting of tumor causing osteonecrosis in an elderly patient?
If previously unirradiated, it is not osteonecrosis, it is cancer invading bone. Yes, I would. If previously irradiated, it’s palliative reRT and, yes, I probably would.