Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you consider using LDRT for joint pain/arthritis caused by aromatase inhibitors as a means to keep patients on therapy?
I would try this. I think there is an inflammatory component to this, and the subjective complaints appear to mimic OA. However, I do think this would be a wonderful group of patients to try this on. They are probably already comfortable with radiation, the achiness/discomfort from ET is real and we...
How do you approach ADT in patients with high-risk prostate cancer who have risk factors for VTE, such as Factor V Leiden?
My default recommendation for patients with localized, high-risk prostate cancer is to recommend the use of long-term ADT. This intervention seems to offer a relatively large, clinically significant OS benefit for patients in the modern era receiving dose-escalated ADT. This benefit has been observe...
What target volumes do you use for rectosigmoid/very superior rectal cancers?
The simple answer is that there should be a major alteration in treatment volumes in these patients, as there should be NO target volume as most of these patients with very high rectal/rectosigmoid tumors do not need to be irradiated at all. If one looks at failure patterns, the risk of local failur...
In what situations would you treat a rectal mass as cancer despite negative biopsies?
It is not uncommon to see a patient with rectal mass highly suspicious for malignancy by endoscopic evaluation but has a negative biopsy. Usually, this is due to superficial biopsy specimens. In our clinic, we usually get repeated endoscopic evaluation with biopsy as our first step. However, a small...
Can symptomatic radiation pneumonitis ever improve spontaneously without corticosteroids?
As “pneumonitis” has always been difficult to pinpoint, and relies on “inflammatory radiologic findings” confined to XRT portals, fever, cough without positive bacterial cultures, and shortness of breath, the diagnosis is even more difficult with 3D-directed and multiple portals or mostly IMRT-deliv...
What dose constraints do you use for RCC/Kidney SBRT?
As is often the case, there is no single answer to this question, and the ALARA principle should always be kept in mind. A good starting place to determine your OAR constraints for a given case is to consider the clinical context. Ultimately, in deciding on allowable OAR constraints, one has to cons...
How are you integrating Prostox into your practice for prostate patients deciding between SBRT and hypofractionation?
Curious how people are using this test?
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...