Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you treat a perineural IgG4-RD with persistent paresthesia?
Perineuritis is an uncommon manifestation of IgG4-related disease (IgG4-RD), but it does occur. In most cases, this is an incidental finding that is not associated with symptoms or nerve dysfunction. This is most often observed in branches of the trigeminal nerve (e.g., infraorbital nerve, frequentl...
In a patient with bilateral neck level II small cell carcinoma with no apparent primary after workup with plans to receive concurrent cisplatin/etoposide, what would be your treatment volumes?
Extrapulmonary small cell cancer, like its lung equivalent, is highly sensitive to chemotherapy but has a high rate of metastatic disease, which is the primary site of failure, with median DFS of about 6 months. If this patient achieves clinical CR after chemotherapy, I would forgo RT. I would consi...
Would you favor radiation or immune modulating treatment like imiquimod to treat an uncomplicated basal cell carcinoma on the nose in an elderly patient for whom you'd like to avoid surgery?
If my patient was concerned about deformity, with 10 to 15 years of life remaining, unquestionably, I would recommend radiation.
What are your top takeaways in GU Cancers from ASCO 2025?
Here are the top 3 prostate cancer studies: AMPLITUDE. LBA5006: Attard and colleagues show that the PARP inhibitor niraparib plus abiraterone/prednisone delayed rPFS in men with mHSPC (HR 0.63, p = 0.0001), meaning this is the first ARPI/PARPI successful combination in this hormone-sensitive HRRm se...
What is your approach to the adjuvant treatment of early-stage mixed-histology endometrial cancer with a significant clear-cell component?
Clear cell carcinomas are under-represented in most clinical trials and hence, clear evidence-based recommendations are difficult to make. Even a small percentage of clear cell is sufficient to label these as “high grade”. The recently published ASTRO guidelines mention that chemotherapy may not ben...
How do you apply hyperfractionated RT in the dose painting IMRT era in head and neck cancers?
I prefer to use the DAHANCA approach (Overgaard J et al, Lancet Oncol 2010) of providing 6 fractions weekly, 2 Gy per fraction, with a second fraction on a Fri (at 6 hours apart). This is an accelerated course delivering 72 Gy to the primary PTV over 6 weeks. Compared with other fractionated regimen...
In a patient with a history of prior BCS+RT for early stage breast cancer who is now s/p repeat lumpectomy for a low risk in-breast recurrence, what dose/fractionation regimens are appropriate for reirradiation?
PBI using IMRT to 1.5 Gy BID to 45 Gy like phase 2 RTOG.If declines, can do once a day conventional fractionation to 45-50.4 Gy.
What CTV expansions do you use for NSCLC with conventional chemoradiation and do you do different expansions based on specific histologies?
We do 5 mm for all chemoRT cases and do not alter based on histology.
Is there an age that is too young for prostate irradiation?
Great question, and quite relevant, given that over 10% of newly diagnosed prostate cancers occur in men 55 years of age or younger. Although I consider a patient's "biological" age (lifestyle, performance status, etc) more than his chronological when deciding the UPPER age limit for radiation, it i...
What are your preferred strategies to manage mild to moderate rectal ulceration causing tenesmus and discomfort after chemoradiation for rectal adenocarcinoma?
Radiation-induced proctitis or tenesmus -- important to determine if the cause is external or internal to anal verge. Also important to rule out rectal fissures as this typically requires a different approach (Analpram cream and high fiber diet, +/- GI evaluation). If the cause is internal to anal v...