Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is your radiation approach/details for regionally involved prostate cancer (N1)?
For intact cases, I usually attempt to deliver a single-phase plan with multiple dose levels in 28 fractions as detailed below:Elective Pelvic LN volume (CTVn1): 50.4 Gy/28 fx. In cases of N1 disease, I would usually include the common iliacs. When the GTVn is near the cranial field edge, I usually ...
How do you approach patients with stage III unresectable, combined histology NSCLC/SCLC?
For stage III lung cancer with mixed NSCLC and small-cell lung cancer, we treat patients with concurrent chemotherapy (cisplatin/etoposide every three weeks) and definitive radiotherapy (60-66 Gy in 30 fractions, QD), followed by adjuvant immunotherapy (durvalumab). The rationales are as follows: Ra...
When you do recommend conventional fractionation over moderate hypofractionation for prostate cancer?
I am routinely using 2.5-3 Gy in patients with low, intermediate, and some high risk patients so I guess I am an early adopter (or a cavalier nutjob). The exclusion criteria from the two published non-inferiority trials of moderate hypofractionation that are relevant to this question are quoted more...
Do you offer postoperative radiation for adrenocortical carcinoma?
I just answered a similar question asking about ACC s/p resection with a positive margin, but the same principles apply here: Adrenocortical carcinoma is a very rare entity, and it is associated with a poor prognosis. I have only treated a few. Despite aggressive resection, there is a high rate of l...
Do you recommend adjuvant XRT for adrenal cortical carcinoma s/p resection with a positive margin?
Adrenocortical carcinoma is a very rare entity, and it is associated with a poor prognosis. I have only treated a few. Despite aggressive resection, there is a high rate of locoregional failure. The data regarding adjuvant radiation after surgery are very limited, mostly small retrospective studies....
When do you initiate vaginal cuff brachytherapy treatment after hysterectomy for early stage endometrial cancer?
We usually start vaginal cuff treatment 5-6 weeks after hysterectomy. If adequately healed, may start at 4 weeks but not before. Rarely more than 8 weeks. For patients receiving vaginal cuff treatment plus chemotherapy, we still give cuff treatment within 6 weeks. There is no reason to delay because...
What are some alternatives to dexamethasone for brain edema in patients who are allergic, have an intolerance, or refuse the medication?
Dexamethasone is one of the most frequently prescribed medications in neuro-oncology clinics. Dexamethasone is often favored over other corticosteroids owing to its lower mineralocorticoid effects and high potency as well as essentially 1:1 oral to IV ratio meaning that we use similar IV and oral do...
When treating endometrial cancer patients with a combination of chemotherapy and vaginal cuff brachytherapy, when do you deliver cuff brachy?
I prefer, most of the time, between the cycles of chemotherapy (1 to 3) based on logistics.
When treating a patient with classic early stage diffuse large B-cell lymphoma (Stage I/II), when is it appropriate for patients to receive 3 versus 6 cycles of R-CHOP chemotherapy when the treatment is followed by ISRT?
The SWOG 8736 study included patients with stage I (bulky or non-bulky) and nonbulky stage II aggressive non-Hodgkin lymphomas (mostly DLBCL). Bulky was defined as a mediastinal mass >1/3 maximal chest diameter or any mass > 10 cm. Patients were randomized to 8 cycles of CHOP or 3 cycles of CHOP + R...
What would your approach be in a man currently on treatment for high-risk prostate cancer with ADT who does not have castrate levels of testosterone?
Yes, I would try alternative agents. If using Lupron, consider relugolix, degarelix, high-dose bicalutamide, or even adding an ARSI.