Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What are your top takeaways in Medical Oncology from SABCS 2025?
lidERA trial. This is the first phase III trial showing an advantage for an oral SERD giredestrant over standard endocrine adjuvant therapy in early breast cancer. Treatment with giredestrant led to a 30% reduction in the risk of invasive disease recurrence over standard endocrine therapy at the fir...
What are your top takeaways in Breast Cancer from ESMO 2025?
ASCENT-03: At ASCO, the results of ASCENT-04 already showed an improvement of PFS (11.2 months vs. 7.8 months) in first-line setting for PD-L1 positive advanced triple negative breast cancer patients treated with sacituzumab plus pembrolizumab compared to chemotherapy plus pembrolizumab. The ASCE...
Will you extrapolate EORTC 1333/PEACE-3 (enzalutamide + Rad223) to any other ARPIs for mCRPC?
PEACE-3 was a cooperative group study of radium-223 plus enzalutamide versus enzalutamide alone in men with mCRPC. There was a significant improvement in OS (38 months vs 32 months). Most patients in the trial were previously treated with ADT monotherapy instead of intensified therapy (i.e., ADT + A...
How do you manage significant gas in patients undergoing pelvic radiotherapy?
This is tough, especially once the simulation is completed, the patient comes in for treatments and now you see very different anatomy. The one thing that I have changed in practice - and I'm aware this is not always possible at higher volume centers - is to have the simulation at about the same tim...
Would you offer upfront radiation for a large painful keloid of the chest that has arisen from an irritated pyoderma gangrenosum lesion?
Radiation therapy is actually used (rarely) for pyoderma gangrenosum that has been unresponsive to medical management via immunosuppression [1]. Single fraction doses of 400 to 800 cGy have been used with slow regression of the lesions. In the case report cited, the lesion started fading after 3 mon...
When do you recommend patients get vaccinations with respect to their RT course?
I agree with @Dr. First Last's reply, and find that some patients are under the impression they are immunocompromised during radiation therapy and thus should avoid vaccines, when in fact the opposite is true. The skepticism behind the science of vaccination also can lead to avoidance, and so I try ...
How will your management of head and neck cancers change with the COVID-19 pandemic?
Short answer: Most head and neck cancer radiation is as necessary as it gets. At this point, my management won't change very much. That may change as the pandemic evolves. Use all the appropriate precautions to stop the spread of COVID-19 and other viruses (we are using masks for every staff member,...
Would you consider modifying T&O fractionation during the COVID-19 pandemic?
We have been using 7gy x 4 instead of 5 fraction regimen in the past. A 2 fraction regimen showed lower local control in comparison to 4 fractions in the IAEA randomized trial.
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 longest acceptable interval between hysterectomy and vaginal cuff brachytherapy for high/intermediate risk endometrial cancer in the age of COVID-19?
We usually start no later than 9 weeks post hysterectomy. It is based on this retrospective study.