Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you offer adjuvant chemotherapy after SBRT for biopsy proven sub centimeter metastatic pulmonary nodule from rectal cancer?
This is a great question and a common scenario we met in the clinic. First, we need to know more about the case, for example, if the patient has synchronous metastatic disease or it is metachronous metastatic lesion; if the patient had neoadjuvant/adjuvant chemotherapy; how long of the disease-free ...
Do you recommend ADT for a patient with hypogonadism with unfavorable or high risk prostate cancer whose PSA dropped to <1 after cessation of supplementation?
When I encounter this situation, I will measure the testosterone level off supplementation. If the testosterone is castrate level (<50 ng/dL), then I would not add ADT, as the target testosterone level has already been achieved. If the patient's testosterone level remains above the castrate threshol...
How would you manage a treatment-naive patient who has painful vertebral lesions from ES-SCLC?
ES-SCLC is incurable. If they are in pain, treat their pain. Chemotherapy is palliative. TRT may extend life, but the average life expectancy with ES-SCLC is limited. Don't let patients in pain suffer when we have an effective way to treat them. I would consider very short courses - 1-2 fx SBRT (per...
How do you manage grade 1-3A Follicle Center Lymphoma of the lower female genital tract, presenting with a cervical mass?
I would treat this with 12 x 2 Gy. Indeed, fertility preservation will be an issue here. Depending on the size of the lesion, if the ovaries can be spared, then 24 Gy delivered to the cervix/uterus may still allow for a pregnancy with a favorable outcome. Another experimental approach, if the patien...
How soon after CAR T-cell therapy can salvage radiation be delivered?
This is another important question. In our practice, the earliest we have treated patients is after their first post-CAR-T PET/CT at day 30. An abstract presented in an oral presentation at this year's ASTRO meeting by Dr. @Dr. First Last describes that radiation to sites of incomplete response at t...
How, if at all, would adenosquamous histology affect your coverage volume compared to squamous cell carcinoma of the head and neck?
No impact
What criteria do you use to determine the utility of DIBH for breast cancer patients?
For PMRT or anyone getting RNI, favor DIBH for all (irrespective of side) to reduce lung (more important as some of the patients get TDM1 and Pembro with RT) and heart dose (as long as the patient can tolerate the procedure). For non-RNI, make a determination only for the left-sided breast based on ...
How would you approach a patient with limited stage SCLC who progressed immediately after completing chemoradiation with brain metastasis?
For 1-10 brain metastases from SCLC, consider the NRG CC009 clinical trial randomizing between SRS and hippocampal-avoidance WBRT!
Is there an optimal salvage radiation dose for relapsed post-CART disease?
While there is not enough data to definitively recommend a specific dose, we feel an EQD2 > 37.5-40 Gy is desirable for patients with limited residual or relapsed disease post-CAR T-cell. Our commonly recommended fractionations include 37.5 Gy in 15 fractions, 40 Gy in 15 fractions, and 40 Gy in 20 ...
Would you offer postoperative radiation for a patient who initially had biopsy-proven multistation N2 NSCLC but had a nodal pCR upon surgical resection+ LND after neoadjuvant chemo-immunotherapy?
I would not routinely offer PORT for completely resected N2 disease based on lack of survival benefit from LungART (have my qualms about ~90% 3DCRT and the probable impact on cardiothoracic toxicity), particularly in a patient who appears to have had a fantastic response to neoadjuvant therapy. I th...