Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you consider once weekly radiation with a simultaneous integrated boost for a patient with node negative breast cancer with a positive margin for whom reexcision is not an option?
If the patient is advised on data and risk, it's not unreasonable. Another alternative is once weekly whole breast and then add a 6th-week boost.
Do the results and approval based on ADAURA trial suggest a role for adjuvant osimertinib in patients with stage IIIB-C, EGFR mutant patients treated with concurrent chemoradiation?
ADAURA trial was not designed to address this issue. But that being said, we need to remember few things before considering "maintenance durvalumab" in patients with EGFR-mutant lung cancer, following chemo-radiation: 1. EGFR-mutant NSCLC patients may not derive any clinical benefit from single-agen...
What criteria do you use in deciding whether or not to treat the pelvis in prostate cancer?
NRG/RTOG 0924 - The end of elective nodal RT in localized prostate cancer? Top line results: NRG/RTOG 0924 is a very large phase III randomized trial powered for overall survival (OS) to determine if there is a benefit of the addition of whole pelvic radiotherapy (WPRT) to prostate RT plus ADT. This...
In a patient with metastatic breast cancer who has progressed on multiple medications and has now developed multiple brain metastases, what is your radiotherapy plan if the patient is taking sacituzumab govitecan?
The limited published data have not shown increased complications with SRS along with sacituzumab, unlike increased necrosis seen with HER2/neu antibody conjugate. Khatri et al., PMID 41026418
When do you treat heterotopic ossification with radiation pre-operatively?
Can pre-op radiation be delivered more than 24 hours before surgery?No — this is not recommended and is generally ineffective.Why timing matters (biologic rationale):HO formation is driven by pluripotent mesenchymal progenitor cells that are recruited and activated by: Initial trauma Surgical manipu...
Can we use a linear accelerator to sterilize PPE?
Per FAQ's posted by ASTRO: "At this time, ASTRO does not recommend the use of clinical linear accelerators to sterilize PPE. While ionizing radiation is used for sterilization of blood and food products, this is achieved using industrial irradiators that use gamma irradiation at doses rates far grea...
What is the recommended follow-up/surveillance schedule following organ preservation treatment approach for cT1-2N0 rectal cancer?
Patients with stage I rectal cancer treated with organ preservation require close surveillance to rule out tumor regrowth and local recurrence that may be salvaged with radical surgery. The highest risk of recurrence is within 2 years after completion of neoadjuvant therapy and patients should be fo...
In light of the pending overall survival data and reported declines in quality of life associated with the PSMAddition trial, how do you envision incorporating Pluvicto into the management of mHSPC?
The PSMAddition trial was a phase III trial of [177Lu]Lu-PSMA-617 (i.e., Pluvicto) combined with androgen deprivation therapy (ADT) plus an androgen receptor pathway inhibitor (ARPI) in patients with PSMA-positive metastatic hormone-sensitive prostate cancer (mHSPC). This trial randomized men with u...
Is a stereotactic/ thin-slice MRI of the brain absolutely necessary to determine eligibility for hippocampal sparing whole brain radiation therapy?
The small size of the hippocampal dentate gyrus (3-4cc) can render it difficult to delineate and conformally avoid if both the brain MRI and the treatment-planning CT simulation are not obtained with thin-slice axial images (not exceeding 1.5mm on the MRI, not exceeding 2.5mm on the treatment-planni...
Would you perform unilateral or bilateral hippocampal avoidant whole brain RT in a patient with a prior SRS to a small hippocampal metastasis?
I would recommend bilateral HA-WBRT and memantine in this situation. The role for HA-WBRT is shrinking over time with a diminishing patient population between the expanding role of SRS for multiple brain mets and no role for cranial RT for poor prognosis patients with no/limited systemic therapy op...