Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What are your top takeaways in Radiation Oncology from SABCS 2025?
Several significant studies were presented at San Antonio this year. I will focus on the three most important abstracts reporting new data from studies of local-regional therapy. (The 10-year update of the BIG 3-07-TROG 07.01 trial comparing hypofractionated and conventional fractionation and the us...
How have you incorporated ctDNA into the clinical management of patients with gynecologic cancers?
ctDNA certainly is increasing rapidly in oncology and has been led by several other disease sites. I think right now, GYN oncology is figuring out how to incorporate this in our care to meaningfully impact our patients. I have not incorporated ctDNA in my practice routinely, but do see the role of i...
How do you sequence antiviral therapy and cancer-directed therapy in a newly diagnosed patient with hepatocellular carcinoma and incidentally found hepatitis C?
According to the recent publication by Cabibbo G, et at, J. Hepatol. 2019, 71, 265–273, yes direct-acting antivirals after successful treatment of early hepatocellular carcinoma improves survival in HCV-cirrhotic patients. No such data or evidence for advanced disease though. in that case, antiviral...
In patients with inflammatory bowel disease with low rectal cancer with planned proctocolectomy, would you consider creation of a pouch?
This is a very difficult case- are you speaking of Ulcerative Colitis or Crohn's disease? If UC - can consider pouch but really depends on the stage of the primary rectal cancer. If neoadjuvant chemoradiation is given, the likelihood of an ileoanal J-pouch functioning appropriately is low. Generally...
Is there an absolute PSA level above which you would not recommend a radical prostatectomy for newly diagnosed prostate cancer despite the absence of metastatic disease with advanced imaging?
There is no absolute PSA level that would preclude radical prostatectomy in the absence of metastasis on staging imaging. However, I would explain to the patient that the chance of occult metastatic disease and the need for additional treatment after prostatectomy increases as the PSA increases. I w...
In a locoregionally advanced breast cancer with multiple positive surgical margins, how safe is it to wait for a re-excision vs treating upfront with comprehensive RT if surgery cannot be done the short term due to the COVID outbreak?
Agreed, higher radiation dose will not replace negative margins. Obtaining negative margins is ideal. If the patient is a systemic therapy candidate, I would agree with @Dr. First Last and proceed with systemic therapy and then re-excision.
Have treatment recommendations changed for Stage I endometrial Cancer based upon PORTEC 4 results?
PORTEC-4a will almost certainly change recommendations for adjuvant treatment in high-intermediate risk stage I patients with endometrial cancer, and in at least 2 different ways, in my opinion. By following the molecular profiling guidelines, nearly half of these patients will avoid adjuvant treatm...
Is it necessary to use double contrast MRI for treatment planning of brain SRS?
"Necessary" is perhaps too restrictive a term, but speaking anecdotally, at Barrow Neurological Institute (BNI) we, for essentially the past 20 years, routinely obtain thin cut (1mm) SPGR double-dose gadolinium MRI to plan radiosurgery for patients with brain metastasis. In support of this, a recent...
What is your treatment algorithm for solitary hepatocellular carcinoma, 3-5 cm, non-operative candidate but Child-Turcotte Pugh A/B?
This really boils down to two issues: CTP score and size of the lesion. For patients who are CTPA with a lesion <3 cm, RFA/MWA or SBRT are good options although there is some data from the University of Michigan (Wahl et al., JCO 2014) that lesions > 2 cm are better served with SBRT. For solitary le...
How would you approach a radiation-induced angiosarcoma of the breast after mastectomy with negative margins?
Based on this research we tend to offer RT for high grade or tumor more than 5 cm or RT induced; there is no good prospective data. Based on UF series, we offer accelerated hyperfractionation 1.5 BID to 45 to 50 Gy, treating only chest wall.