Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Should regional nodes be included in whole breast RT for a favorable pT3N0 breast cancer after lumpectomy and SLNB?
I do not typically recommend RNI in a T3N0 following breast conserving surgery with negative SLN. While patient factors such as young age and pathologic factors ER-/Triple negative, LVSI concern me, they are not enough for me to offer RNI in a node negative patient.
How do you choose between neoadjuvant and adjuvant chemo-immunotherapy for patients with resectable stage II-IIIA NSCLC?
The billion dollar question. For patients with resectable stage II-IIIA NSCLC, how do you choose between neoadjuvant and adjuvant chemo-immunotherapy in light of the recent FDA approval of the CheckMate-816 regimen? Of course, this approval quickly followed in the footsteps of the FDA approval of at...
What are your top takeaways from ASCO GU 2025?
In terms of practice-informing presentations in prostate cancer here are my top 3: GROUQ-PCS 9 trial (Canada, abstract 22). This trial led by Niazi et al tested whether metastasis-directed radiotherapy based on conventional imaging to up to 5 sites provided benefits in delaying rPFS or PSA progressi...
How do you approach post-lumpectomy surveillance in male breast cancer patients without BRCA or other mutations?
Annual mammograms, with additional sonogram if needed.
For a patient receiving postmastectomy IMRT to chest wall with expander and regional nodes including IMN, what constraint would you use for dose to the contralateral chest wall/implant if the patient also had a mastectomy and reconstruction on that side?
I use similar numbers and tend to accept a more generous approach to achieve coverage if the patient has undergone a contralateral mastectomy vs intact breast.
Does delay to the time of lumpectomy impact your decision to omit radiation?
There seem to be two issues to consider in this situation. One is whether patients undergoing neoadjuvant endocrine therapy, then lumpectomy without RT, have an acceptable local recurrence rate. The only study I know of directly addressing this issue was presented at a poster session of the 2017 San...
How do you approach breast hypofractionation RNI with the results of the Skagen Trial 1?
There are multiple prospective/randomized studies showing non-inferiority for complications or cancer outcome with hypofractionation and RNI, including Wang et al., PMID 30711522, HypoG-01, FABREC, RT-CHARM, and the subset arm of STARTb. The primary endpoint of DKSG was also lymphedema, which was no...
Are there situations in which you would definitely recommend radiation in an elderly patient with ER+, early stage breast cancer?
I always have a little trepidation in answering questions whereby I would “definitely†recommend any therapeutic path as clinical decision making needs to be a bit more nuanced. Every situation requires a careful weighing of multiple inputs including clinical trial data and patient-specific fact...
How do you counsel families of pediatric patients regarding risk of secondary malignancy or IQ changes with cranial radiation using photons?
It’s a great question as these are two of the scariest things that families face when you relay the potential risks of cranial radiotherapy. Simple things like timing of these topics in the consent discussion can make a difference. Don’t start with the scariest potential risk when doing the consent,...
What is your approach to post-operative radiation (when to offer, volume, dose, fractionation) for a primary intraosseous squamous cell carcinoma (PIOCC) of the head & neck?
I probably would. 60 Gy in 30 fractions for negative margins and electively treat the neck.