Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Should systemic therapies be added to ADT and salvage RT in patients with PSAs >2 ng/mL after RP?
The question is asking for patients who underwent RP, and the PSA either was persistently elevated to ~2.0 ng/mL, or was observed until it was 2.0 ng/mL, what is the standard of care. The only salvage RT trial that really enrolled men at a PSA of 2 or higher was RTOG 9601 (GETUG-16 allowed up to 2.0...
Would there be any contraindication to whole pelvic RT for a patient with an ax-bifem bypass & the graft crosses the lower abdomen within the RT field?
I am not aware of any contradiction and have treated patients with peripheral bypass
Should radiation therapy be offered to the prostate +/- pelvic nodes in a patient who had PSMA PET/CT positive pelvic LN and prostate disease that resolved after a year of ADT?
Difficult to say but.......PSMA (Prostate specific membrane antigens) PET scans, are undergoing active clinical trials is seemingly the way of the future for imaging in most PCs cases as opposed to the current use for Axumin PET scans which are used for PSA progression only, to date. In this patien...
Would you offer post-operative radiation to a patient with a parotid basal cell adenocarcinoma after a negative margin resection?
Depends on grade. I think they are usually low grade so no. Anything high grade and adenoids cystic carcinoma, yes.
What are the current recommendations for androgen blockade for patients undergoing salvage radiation after prostatectomy with PSAs between 0.6 and 1.5?
Just be a little careful here. Although Dr. Spratt did an amazing analysis and thorough presentation of the subgroups, one shouldn't look at PSA <=0.6 as a "cutoff". As Dr. Spratt pointed out in his presentation, the population on RTOG 9601 was mixed in terms of prognostic features.. Would you reall...
How often do women develop HPV associated oropharyngeal cancers?
HPV associated Oropharyngeal SCC is much more common in Men than Women, nearly 3-4 times higher. One possible explanation is higher prevalance of HPV virus in female genitalia as compared to men, however, biological differences in viral clearance may also be a factor. Although, the incidence of HPV ...
In the setting of prior salvage radiation therapy for rising PSA post prostatectomy, can there be any role of additional radiation therapy for isolated local recurrence in the bladder neck/prostate bed?
I have not run into this scenario. If it is visible on imaging (ultrasound +/- CT or MRI) I would explore the possibility of HDR, 13.5 Gy x 2. Careful consideration would need to be given to the location of the recurrence and anatomy. Technically it may be challenging due to scar tissue and the limi...
Would you omit a lumpectomy boost in a patient with a single positive sentinel lymph node, with a primary tumor that is otherwise favorable?
For luminal A breast cancer like her benefit of boost is very limitedm as IBTR is 1-3% and sentinel nodal status would not influence decision not to boost.
In patients with rectal cancer receiving neoadjuvant chemoradiation, how does possible seminal vesicle involvement on MRI affect the contours of your target?
I would include the entire seminal vesicle with a margin and add the external iliac nodal region in prophylactic volume.
How do you approach early stage, mixed histology lung cancer (SCLC and NSCLC components) in patients with good performance status?
Certainly the simplest approach for an early stage mixed SCLC/NSCLC would be upfront surgical resection and node dissection (provided that good performance status implies medical operability), and then pathologically if a true small cell component is confirmed (or if the patient is found to be node ...