Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In the IMRT era, what role does brachytherapy play in the treatment of squamous cell carcinoma of the vulva?
We very rarely use brachytherapy to treat vulvar cancer because our experience (and that of others) has been that the rates of necrosis with brachy are very high. Any source that comes too close to the vulvar surface will cause necrosis that typically heals very slowly. Even with the best technique,...
What treatment recommendations for a low or intermediate risk prostate cancer do you consider when treating patients with medical commodities such as ankylosing spondylitis and ulcerative colitis?
I do not think either of these would be a contraindication for radiotherapy. I have some experience with patients with ulcerative colitis, but not with ankylosing spondylitis. If there is any concern, either HDR or LDR brachytherapy are the most attractive options. The volumes for low and intermedia...
Should we be integrating tumor treating fields into standard glioblastoma treatment?
The EF14 trial preliminary results were just published in JAMA and demonstrate an improvement in both PFS and OS for the experimental arm, and the device has received FDA approval. In the neuro-oncology community, there is still anticipation regarding the final results (the entire cohort outcome dat...
Based on data from CREATE-X/JBCRG-04, would you consider adjuvant capecitabine in breast cancer patients treated with neoadjuvant chemotherapy who do not achieve a pCR?
Yes, 6-8 cycles of adjuvant capecitabine has been shown to improve survival in one randomized trial and therefore should be offered and disused with a patient. If capecitabine is given it could be given after surgery followed by radiation therapy or radiation may be completed first. Both options wer...
Which patients would you offer a watch-and-wait approach versus surgical resection after chemoradiotherapy for patients with rectal cancer?
I would never offer watch and wait as an alternative, even in the patients with an apparent clinical complete response, and I would attempt to dissuade any patient from pursuing this approach. Even after apparent clinical complete response, we frequently see pathologic evidence of residual disease. ...
Would you consider whole breast irradiation in a woman who develops a second primary breast cancer or recurrence after lumpectomy and partial breast balloon brachytherapy and declines mastectomy?
In the case of a recurrence or second primary where the original irradiated soft tissue will be resected, I would first review the amount of dose delivered from the original APBI to the chest wall and skin. I am mainly thinking of APBI delivered with a brachtherapy technique. If the dose was more li...
Is there a role for docetaxel for men with high risk prostate cancer receiving radiation and androgen deprivation therapy?
Standard of care for high risk localized prostate cancer remains radiation and long term androgen deprivation therapy. To date, there are no trials that have demonstrated an overall survival benefit with the addition of chemotherapy. Given the potential toxicity of adding chemotherapy, this should n...
How do you use a 4D CT to account for hepatocellular carcinoma tumor motion?
If your IGRT solution is KV imaging, then implanted fiducals are very important for multiple reasons. However, to take full advantage of having them in place, I recommend using an inspiration breath hold technique as well using the Varian RPM system or gating belt that comes with the True Beam. This...
How do you manage patients with low-lying rectal adenocarcinoma who refuse surgery?
There is no simple answer to this question. There is a long history of patients being treated primarily with radiation therapy, but the interest has been much greater in the past few years with the publication of the Brazilian and other data. First, a word of caution regarding this paper in that the...
How does a close DCIS margin factor into surgical and radiation decision making for Stage I invasive ductal carcinoma after breast conserving surgery?
Based on SSO and ASTRO guidelines for invasive tumor, no tumor at inked margin is considered negative by us for suitability for adjuvant RT. If there was calcification as part of the mammographic finding, then for close DCIS we would look at the specimen radiograph and also consider pre-RT mammogra...