Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is your preferred regimen for HDR monotherapy in the treatment of low and favorable intermediate prostate cancers?
At UCLA, we now use 13.5 Gy x 2 fractions for most cases. The two implants are done 4-7 days apart (some cases are Monday and Friday). We also use this program for some favorable high-risk-group patients.@Dr. First Last (brachytherapy division director) uses slightly different dose constraints. Salv...
Would you treat a localized radiographic prostate failure after EBRT with HDR brachytherapy?
I agree that a biopsy is needed and that you can't just rely on suspicious imaging findings. mp-MRI can underestimate the true extent of disease and is not 100% specific. Also if one is considering focal salvage, tt is critical to understand the full extent of recurrent disease. There are multiple s...
Do you omit seminal vesicle radiation if MRI is negative for SVI?
No. MRI has excellent specificity (>95%) for seminal vesicle invasion, but much less impressive sensitivity (<60%). See de Rooij et al. European Urology 2016 (PMID: 26215604) for a meta-analysis and a nice study by Soylu et al. Radiology 2013 (PMID: 23440325 PMCID: PMC6940014). So, MRI can be very u...
How would you manage locally advanced head and neck patients getting definitive chemoradiation who show progression halfway through treatment?
I have seen this twice within the last year. Here is what we did: 1) First patient had high risk cutaneous SCC s/p WLE and neck dissection. He progressed in the skin after surgery when seen for sim, and continued to progress during first week of RT. We stopped RT, started cemiplimab. He had a remark...
How would you manage initially unresectable node-negative pancreatic adenocarcinoma that after upfront chemotherapy achieves a complete radiographic response on interval MRI and CT?
This is an interesting question and, in my experience, something that is not commonly encountered clinically. I will assume here that the patient has no visible sites of disease elsewhere. Still, given that scans are a poor predictor for pathologic response and complete response in pancreatic cancer...
How would you approach re-irradiation to a localized DLBCL of the lower extremity?
Unfortunately I need a few more details to answer this. This appears to be a complicated difficult case. I presume the initial dx was DLBCL of the skin, leg type? Age of the patient? What was the response to R-EPOCH? Was the RT given as consolidation or was there disease present? If so, response to ...
Would you recommend pre-op radiation for an operable recurrent well differentiated retroperitoneal liposarcoma with abutment of the right kidney?
Thank you for this question. Per the STRASS trial (Bonvalot S, Gronchi A, Le Pechoux C, et al. Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019) 11001-11001), preoperative radiation overall did not impact abdominal recurrence free survival. However, in the exploratory analysis, the lipos...
Are you considering SBRT in your prostate cancer patients who had a RP and now have a rising PSA and oligometastatic bone disease?
Yes, we offer SBRT for oligometastatic disease, with a frank discussion of current understanding of the potential benefits and risks. We await results of phase III trials, but smaller trials have been encouraging for a progression-free survival benefit (SABR-COMET, STOMP, ORIOLE).
How would you approach treatment of residual melanoma in situ of the perianal skin?
It sounds like this is a case of mucosal melanoma of the anal canal, with extension on to the perianal skin? Alternatively, this could be a case of true cutaneous melanoma on perianal skin. Further investigations might be helpful to clarify.In either case, this is an unusual situation in this anatom...
Would you give preop chemoradiation to a rectal cancer just above the peritoneal reflection with pelvic nodes seen on imaging?
Yes.