Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you manage rectal wall infiltration during a rectal spacer procedure?
At ASTRO 2023, PACE-B reported RTOG grade 2+ GI toxicity was exceedingly low at only 1/348 for 78 Gy/39 fx or 62 Gy/20 fx and only 1/363 for 36.25/5 fx. Anyone know what % of patients in PACE-B had SpaceOAR or similar products? This raises the question of whether SpaceOAR or similar products are nee...
Is there any threshold regarding extraprostatic extension to contraindicate a rectal spacer?
This is an important question, and as far as I know there are no data to guide a response. I personally believe that EPE (within reason) is not a contraindication to hydrogel. One would expect the extension, capsule and prostate to lift in unison, depending on where the extension is. The NCCN guidel...
How would you treat an early-stage ER/PR+ Her-2 negative breast cancer s/p lumpectomy in an elderly patient who had sentinel node biopsy omission?
I consider these patients as being managed appropriately surgically based on CALGB and current guidelines. As such, I routinely offer these patients APBI.Unless there are other features, I do not think these patients need WBRT just because they didn't have a SLN. If they are eligible for omission of...
When selecting mCRPC patients for Pluvicto, which baseline variables do you find most useful or predictive of potential hematologic toxicity?
One important consideration in the recommendation of Lu-177-PSMA radiopharmaceutical therapy (RPT) is an assessment of a patient’s marrow reserve, as hematologic toxicity is one of the most common clinically relevant toxicities after such treatment. Important clinical features to help assess the lik...
Would you consider utilizing pembrolizumab/enfortumab as a bladder preservation approach in patients with MIBC?
Yes, I think that this is a viable approach. Data from perioperative trials, including KN-905 and EV-304, suggest very high rates of pathologic complete responses in almost two-thirds of all patients at the time of radical cystectomy. Many of these patients may not need radical cystectomy for an opt...
In patients with advanced endometrial cancer who you plan to treat with chemotherapy + immunotherapy (per GY018 or RUBY), how and when do you utilize adjuvant EBRT and/or brachytherapy?
Reading the question at face value - does advanced endometrial cancer mean stage IVB? III/IVA? If IVB, there is not routinely a role of 'adjuvant' EBRT or BT.Given the discussion of adjuvant therapy, I presume the question is asking for the small fraction of RUBY and GY-018 patients who were stage I...
How would you manage a high grade acinic cell carcinoma of the parotid with isolated recurrence in the ipsilateral neck s/p salvage resection?
For this patient with a neck recurrence and (presumably) no evidence of primary site recurrence who had been treated with RT previously to the parotid bed, I would treat ipsilateral neck levels IB, II, III, IV, and V. While IB coverage may be controversial, if the recurrence was in level II, I would...
What are the indications for adjuvant radiation for a resected acinic carcinoma of the parotid?
Although considered low risk, acinic cell carcinoma may be unpredictable. I would add postop RT for very close margins. PNI would depend on extent of nerve involvement. I would if it was extensive. I would not for LVSI. I would in the unlikely event of positive nodes.
How do you manage sexual dysfunction in women receiving ovarian suppression for breast cancer?
Asking questions about sexual dysfunction during routine follow ups is important. Many women may feel uncomfortable bringing up the issue. Next important to evaluate contributors such as physical complaints of dryness, dyspareunia, or libido issues, body image concerns, or relationship concerns. Phy...
What duration androgen deprivation do you recommend with salvage pelvic radiotherapy for pelvic node relapse after prostatectomy?
6 months ADT, 2 years ADT, 2 years ADT + abiraterone/prednisone seems reasonable depending on the circumstances. For example, early pelvic node recurrence for pT3b Gleason 4+5 would be a higher risk than a very late recurrence of pT2 Gleason 3+3.