Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
For bone metastases requiring surgical stabilization, what time interval from the date of surgery do you use for post-op radiation?
Generally, the surgical stabilization minimizes the capability of short-term catastrophe in (like path fracture), what I presume to be a long bone that has undergone surgical stabilization. I'd probably want to give a few days just to maximize local wound healing but starting sometime, maybe 1-2 wee...
In stage IIIC endometrial adenocarcinoma, does the finding of positive pelvic or para-aortic nodes after lymphadenectomy influence your whole pelvic dose?
The pelvic or pelvic plus pa dose is 45 Gy in 25 fractions for us but these suspicious nodes we would deliver concomitant boost dose of 55 Gy in 25 fractions . Iif patients have a positive pelvic node and the pa nodes were not assessed surgically we would extend field to cover pa region up to renal ...
Would you omit post-lumpectomy radiotherapy for high clinical risk, but low molecular risk DCIS?
For now, I have been only omitting/discussing omission if both, clinical path and molecular test are concordant.
How does LVI affect PMRT decision in a node positive patient?
I consider LVI a risk factor for node positive patients and do use as part of my consideration for PMRT.
What is your approach for PMRT when the patient has a DIEP flap?
I would say that the presence of a DIEP flap does not change my approach to PMRT much. I look to cover the chest wall and regional nodes (+/- IM nodes) similar to a flat chest wall or expander/implant case. In my experience, the only change that sometimes happens is planning as the DIEP can sometime...
What is your criteria for undetectable PSA value after prostatectomy?
In the era of ultra-sensitive PSA, reading below threshold of .2 ng/ml also reflects biochemical recurrence especially in the right context. That being said, if values are low like above, we generally repeat PSA to see the trend rather than act on treatment on single value.
Can you safely proceed with breast irradiation during treatment with immunotherapy?
In KEYNOTE-522, RT was done with concurrent Pembro after NACT plus IO and no significant additional untoward effect was reported. So, we do RT routinely with Pembro for these patients.
Would you offer salvage radiation for a local recurrence of prostate cancer that was initially treated with SBRT?
At this time, I’m not sure there is enough data to recommend a course of re-irradiation after primary SBRT outside of a clinical trial, although I do know some who offer it. The majority of the data regarding re-irradiation for local recurrence after RT comes from smaller retrospective reports, alth...
Is it time to re-evaluate the timing of radiation and chemotherapy with the adoption of hypofractionated courses of radiation for breast cancer?
Clinicians began treating patients commonly with both RT and chemotherapy (CT) in the 1970s and 1980s. They tried many approaches, including giving RT first; giving all CT first; giving a "sandwich" of several cycles of CT, then RT, then completing CT; and giving concurrent RT and CT, with RT starte...
In light of PORTEC-3 and GOG 249 data, do you use adjuvant radiation therapy alone in stage Ib serous endometrial carcinoma?
The answer is still not clear but these studies do suggest limited impact of chemotherapy in early stage adverse pathology endometrial cancer. The confounding factor is that these studies combined clear cell and UPSC together and which diluted the power of the study. Chemosensitivity of CC is not sa...