Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you manage intradural - extramedullary metastases of the spinal cord from non-CNS malignancies?
The optimal approach to treatment of intradural-extramedullary (IDEM) metastases of the spinal cord from non-CNS malignancies usually requires a multidisciplinary approach and is also a function of several factors; The histopathology of the disease (is the disease radiosensitive?) The location of t...
How would you treat a BRAF WT metastatic melanoma patient with leptomeningeal disease in the frontline setting?
LMD from melanoma carries a dismal prognosis (weeks to a few months of survival), depending on how symptomatic the patient is from the increased intracranial pressure. Please refer to a case report I published a while ago with Dr. Ahmad Tarhini from Moffitt Cancer Institute for a discussion of this ...
What dose do you prescribe when treating the prostate in patients with low metastatic burden and what are your dose constraints?
I follow the STAMPEDE regimen - either 55 Gy in 20 daily fractions or 36 Gy in 6 weekly fractions. One of the imperatives of the STAMPEDE investigators was to not subject men with low volume metastatic prostate cancer to toxicity - and they found these doses of did not, while still significantly imp...
Do you recommend salvage radiation therapy to limited recurrent Ewing's sarcoma bony lesions?
Depending on the age of the patient, size, and location of the tumor, SBRT is often an attractive option for re-irradiation for a limited volume recurrence from Ewing sarcoma that failed to respond to prior conventional treatment. There is data from Mayo Clinic (Brown et al., PMID 25548538) and MSK ...
What are your top takeaways from SGO 2025?
Results from the NRG Oncology GOG-0263 phase III clinical trial testing the addition of cisplatin-based chemotherapy to adjuvant radiotherapy following radical hysterectomy for patients with early-stage, intermediate-risk cervical carcinoma indicated that the addition of chemotherapy did not improve...
Does the presence of a POLE mutation in endometrial cancer guide your recommendations regarding adjuvant radiation?
It’s part of PORTEC 4 study to randomize patients to adjuvant RT based on molecular subtype. They are exploring if observation is suitable option for POLE type Outside of a trial we still decide based on stage and grade for adjuvant treatment and not on molecular subtype.
Is 500 cGy x 5 an appropriate palliative regimen for a patient with a low-lying metastatic rectal cancer with ongoing pain and bleeding despite chemotherapy?
25 Gy in 5 fractions is my preferred regimen for palliation of a symptomatic rectal primary in patients with metastatic rectal cancer. I’ve used it numerous times with generally very favorable results for symptom palliation, local control, and tolerance. There is also a couple of series which have u...
Would you treat with extended field pelvic radiation for a patient with FIGO IIIC1 endometrial cancer who was found with isolated tumor cells (ITCs) on a single paraaortic sentinel lymph node?
I would favor pelvic and PA nodal RT as it has an increased risk of additional disease in the PA region with a combination of pelvic node-positive and ITC in PA node.
Is there a role for adjuvant nodal irradiation for early stage squamous cell carcinoma of the penis?
Data to answer this question are limited to retrospective analyses given the relative rarity of penile cancer. A PET scan can also be useful in absence of surgical evaluation of the regional nodes. Sanchez-Ortiz and Pettaway (2004) have compiled the results of several case series in attempt to help ...
Are there any circumstances where you recommend early institution of systemic therapy for patients with solitary plasmacytoma?
Assuming a true solitary plasmacytoma with no bone marrow involvement, I do not recommend systemic therapy in almost all circumstances. However, there are times when the location of a solitary plasmacytoma precludes definitive/curative dose radiation; even with surgical resection, I would favor syst...