Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
If a patient with initially borderline resectable pancreatic cancer receives neoadjuvant CHT followed by CRT and is ultimately deemed unresectable, do you consider an RT boost?
I am careful not to give low-dose preop radiation to someone who might not have surgery. We have done a prospective trial to show that surgery is safe after an ablative dose (Reyngold et al., IJROBP, 2025). There is no published evidence that a boost after a two-month break will be helpful or safe, ...
Is there a role for re-irradiation of a recurrent keloid?
The answer is yes.We follow the dose schedule as highlighted in this review by Dr. Flickinger.Flickinger, PMID 20472370.
Would you offer SBRT for primary pulmonary adenoid cystic carcinoma in a patient who was medically not a surgical candidate?
Obviously, a data-free space given the rarity of this disease state. I have routinely utilized SBRT for oligoprogressive lung metastases from adenoid cystic carcinoma with excellent safety and efficacy, and think this is readily extrapolated to a primary ACC of the lung. There are very limited serie...
How do you account for dosimetric contributions from 177Lu-PNT2002 when planning SBRT?
This is challenging and will be a timely question. In this specific trial, we did perform timed SPECT/CT scans after 177Lu-PNT2002 to try to compute dose to various OARs (and tumor). It is difficult to model this, but there are some published references that allow one to estimate the dose contributi...
Do you ever prophylactically treat an asymptomatic bone metastasis to prevent or delay risk of pathologic fracture?
Yes, this is a situation I have encountered before and I think it is very reasonable to deliver prophylactic RT if there is cortical thinning indicating fracture risk, or if there is documented growth of the metastatic lesion, even in the absence of any symptoms to palliate. Another situation in wh...
How would you manage a patient with bilateral adrenal metastases if SBRT is not an option?
Clarifying question: Why isn't SBRT possible? Even for difficult lesions with direct abutment of the duodenum, other small bowel and stomach dose escalation can be accomplished by generating heterogeneous plans that cool off the dose at the OAR interface. I generally prescribe 40-50 Gy/5 fractions, ...
How would you approach neoadjuvant radiation therapy for an adenocarcinoma of the anus involving the perirectal skin in a patient with a history of total proctocolectomy with an ileoanal J-pouch anastomosis?
I think it is likely that this is a patient with UC. The fact that this is an adenocarcinoma and that it involves the peri-anal skin with a possible positive iliac node means that there is no possibility of preserving the sphincter using surgery. The tumor is likely arising in the residual bowel and...
Would you recommend adjuvant radiotherapy in addition to chemotherapy in gastric adenocarcinoma s/p gastrectomy with a distal positive resection margin?
This is one of the indications for adjuvant chemoRT for gastric cancer. This patient is pT4a, pN2, R1/2 disease, and grade 3. They probably should have gotten peri-operative FLOT4, in which case the path would be ypT4a, ypN2, R1/2. Either way, the NCCN guidelines support the use of adjuvant radiatio...
Would you offer adjuvant chemotherapy/immunotherapy for resected pure squamous cell carcinoma (T2-T4 or N+/-) of the renal pelvis?
Primary or pure squamous cell carcinoma of renal pelvis is very rare and the role of adjuvant therapy after surgery is unknown. Squamous cell carcinomas in head-neck, anal and other sites, tend to recur locally. Based on that behavior, I would offer radiation with a sensitizer, preferably weekly cis...
Do you have a size limitation (e.g. >3cm) for offering SRS for pituitary adenomas if OAR tolerances can otherwise be respected?
While pituitary adenoma size plays a role in my decision making for SRS, I would also take into account dose constraints to the optic apparatus. For single fraction, I like to keep my optic nerve and chiasm max dose under 8 Gy. If I am unable to achieve that, I would consider hypofractionation in 3 ...