Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How has COVID-19 altered your recommendations for invasive mediastinal staging for NSCLC?
I just had this discussion with our chief of interventional pulmonolgy at MD Anderson. Some of his faculty are being asked to staff our COVID-19 patient floor. In addition, bronchoscopy procedures should be considered high-risk procedures, and are required to have at least 45 minutes in between proc...
Does the presence of cribiform histology at biopsy in prostate cancer affect your management in an otherwise intermediate-risk prostate cancer?
There have been no trials on this specific question, so there is room for debate and more science (hoping our recent grant submission in this area gets funded...). Here is my current thinking. This is for generally healthy patients with long life expectancy (≥10 years, but especially if ≥15 years). ...
Would you employ high tangent fields for a sentinel node biopsy with isolated tumor cells (ITCs)?
For ITCs, I would favor treating it like a node-negative approach. So I would also offer APBI if suitable; otherwise. If doing whole breast, part of the low axilla gets some RT, but don’t chase it.Mamtani et al., PMID 28429197
For a patient with IIIC1 (micromets), MSI-high, Grade 2 endometrial adenocarcinoma who has undergone full surgical staging, do you recommend adding immunotherapy to adjuvant chemotherapy + radiation?
Short answer: No, I do not recommend adjuvant CT/IO + RT for this patient based on the patient's risk factors in the prompt, and the data below. Should the patient have recurrent/metastatic disease following adjuvant CT + RT/VCBT, then I/O + CT is a good option. Ongoing trials hope to answer this qu...
For treatment with EBRT for H&N cancers, what is the consensus for CT simulation?
I agree with Dr. @Dr. First Last regarding the impact of CT contrast on IMRT/VMAT-based planning. Although I do not routinely perform a contrast and a non-contrast scan on H&N patients. The impact of IV contrast on IMRT dose distribution has been extensively studied, and the impact on the H&N region...
Would you consider applying the principles of STAMPEDE with <5 oligometastatic non-regional lymph nodes from prostate cancer?
About 25% in STAMPEDE had low volume metastatic disease with no bone Mets, with most having a non-regional node in that category to qualify as low volume Mets.That being said, common iliac could be the primary drainage of prostate cancer based on SNLN studies and I would favor treating like node-pos...
What are your top takeaways in GU Cancers from ASCO 2026?
1. A-DREAM (Alliance A032101): Can We Give Patients a Break from ADT?For men with APMS prostate cancer who achieve exceptional biochemical responses to testosterone suppression (TS) plus an ARPI, can treatment be safely interrupted to allow testosterone recovery and improved quality of life?Single-a...
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.
Would you use upfront atezo/bev in a patient with HCC and untreated hepatitis?
Yes. I would not have concerns. For HBV, I would start treatment before or simultaneously. Studies have varied by protocol about the HBV viral load being under 500 or 100 but it is not clear this matters. There have not been flairs reported. In regards to HCV, again, not an issue for me.
Would you ever consider treating a patient with locally advanced NSCLC with SBRT to the primary tumor plus conventional mediastinal chemoradiation?
I have used the technique when the primary is far away, and conventional techniques would give a large PTV on the primary due to respiratory motion. Options in that case would include breath hold, abdominal compression, or phase gating for all 30 fractions of a conventional plan, or treating the med...