Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you consider a patient with DLBCL to have CNS involvement if no brain lesion is seen on imaging, CSF flow cytometry is negative, but PCR is positive for MYD88 and KMT2D mutations?
Cerebrospinal fluid (CSF) is an ultrafiltrate of plasma contained within the ventricles of the brain and the subarachnoid spaces of the cranium and spine. It is possible that cfDNA fragments containing MYD88 and KMT2D mutations may have found their way into the CSF and thereby detected by PCR techni...
Would you recommend radiotherapy for upper-tract urothelial carcinoma in an inoperable patient?
I am hardly an expert on the topic, but have performed SBRT in this scenario. I found this paper very helpful for treatment planning. Evans et al., PMID 29556581.
What treatments, after appropriate dose reductions/delays, do you offer for patients with oxaliplatin-induced cold allodynia/dysesthesia?
The primary treatments that I use for cold-induced oxaliplatin neurotoxicity are reducing the oxaliplatin dose and limiting the duration of oxaliplatin treatment (usually not more than 16 weeks of oxaliplatin-containing therapy in the initial line of treatment). Medications that are effective for pa...
Is there evidence for any difference in outcomes or complications for patients with Crohn/IBD who receive low-dose radiotherapy for hip osteoarthritis?
I'd be surprised if there is any data on this topic; if there is, I am unaware of it. I think the risk of RT-related complications in this situation is quite low. However, if presented with this situation, I would: a) obtain informed consent recognizing the possibility of an adverse result, and b) c...
When treating breast cancer patients with RNI, how often do you include internal mammary nodes?
Treating the internal mammary nodes (IMNs) increases heart and lung exposure; hence, the value of prophylactic IMN RT has been controversial for decades. Randomized trials suggest there may be some benefit to such treatment but disagree on which patient subgroups benefit most or not at all.A trial c...
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...
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...