Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you decide timing of adjuvant radiation with respect to chemotherapy for a patient with resected pancreatic adenocarcinoma with microscopic positive margins?
Level 1 evidence supports chemotherapy, FOLFIRINOX is the standard. The benefit of radiation is modest in comparison and based on post-hoc analysis of phase III trials (ESPAC-1, and others that are themselves nearly uninterpretable). The answer to this question is chemotherapy followed by restaging ...
Would you offer adjuvant radiation in addition to chemotherapy for a patient with stage IIIC uterine carcinosarcoma with cervical involvement?
This is a hard situation as there is no clear data for the exact treatment plan. For surgically staged patients with stage IIIC uterine cancer our tumor board treatment plans typically include discussion of PORTEC-3 (de Boer et al., PMID 31345626) and GOG-258 (Matei et al., PMID 31189035). Patients ...
How soon after SpaceOAR placement can radiation planning CT be performed?
At Univ of Utah, we serve a geographic footprint equivalent to 20% of the United States. As such, many patients travel from 100s of miles away from therapy at our center. We put in spacers, and perform CT simulation on the same day (usually 2 hours apart). Never noticed any significant issues with d...
How do you manage prostate cancer in patients that cannot swallow pills?
The only one suitable for feeding tube administration is apalutamide (must be 8 French or greater feeding tube size). My oncology pharmacist suggests tablet(s) can be placed in a syringe (whole, not crushed), distilled water then added, shaken vigorously to disperse contents, administered through...
What are your top takeaways in Gyn Cancers from ASCO 2025?
We had some exciting abstracts for ASCO 2025! These gynecologic oncology abstracts highlight some truly impactful advancements. Here's a concise breakdown of the key findings and their potential implications: 1. CALLA Trial – ctDNA Detection in LACC (Abstract #5502, Dr. Mayadev et al.)Study Focus: E...
What are the best radiation therapy options for a young adult with 3 brain metastases from myeloid sarcoma that hasn’t responded well to intrathecal therapy?
The prognosis for young adults with Acute Myeloid Leukemia (AML) experiencing a Central Nervous System (CNS) relapse is generally poor, with most studies reporting a 5-year overall survival rate of ~11%, indicating a very grim prognosis due to the aggressive nature of CNS involvement in AML.The prec...
Under what circumstances would you consider irradiation for brain metastases with active or recent bleeding?
Melanoma and renal cell cancer brain metastases are prone to bleed. When metastases bleed, usually they cause acute symptoms depending on the location within the brain (seizures, sudden onset headaches, acute motor dysfunctions, etc.). These patients are commonly seen in the Emergency Department, at...
What do you recommend to a patient who has biopsy positive DCIS or invasive carcinoma and at time of lumpectomy the pathology is benign (assuming biopsy pathology and post surgical tumor needle localization verified)?
I use the same factors in these cases as I do in any DCIS case with regard to estimating the risk of local recurrence and therefore the benefit of radiation: patient age, DCIS grade, margin status, size of DCIS, and ER/PR positivity. With regard to grade and ER/PR positivity, that information should...
What stomach constraint would you accept in abdominal reirradiation?
For patients with at least one year interval, we reduce the standard GI luminal constraints by 10%. We use a point dose constraint as well as a 40 cc constraint. We almost always use 1.5, 1.8, or 2 Gy per fraction. For example, for 45 Gy in 25 fractions or 39 Gy in 26fx fractions BID, we would allow...
Can palliative radiation be used to treat recurrent malignant pleural effusion in NSCLC?
There has been gradual recognition of improved survival with the administration of three-dimensional radiotherapy (3D-CRT) to the primary tumor in the context of systemic chemotherapy, EGFR-TKIs, or immunotherapy in patients with stage IV non-small cell lung cancer. (Zheng et al., PMID 31040256, Arr...