Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Can SpaceOAR be inserted a second time?
I had the same thing happen and placed a second SpaceOAR without difficulty. I also have a few cases where the patient had a local recurrence, and a second rectal spacer (after prior radiation with a rectal spacer) was used without difficulty. Please be aware that placement of a rectal spacer after ...
Which types of pancreatic cancer patients should we consider sending to a center that offers EUS-guided Radiofrequency Ablation (RFA) therapy?
EUS-guided ablation for appropriately selected mucinous pancreatic cysts and, to some degree, neuroendocrine tumors is becoming increasingly standardized with multiple reviews on the subject. (Rodger et al., Techniques and Innovations in Gastrointestinal Endoscopy 2024, Moyer & Canakis, PMID 3879629...
Would you offer empiric lung SBRT for two growing FDG-avid lung lesions in a patient with severe COPD on oxygen?
This is a good question! The short answer is yes, most likely. Many patients are too high-risk to receive biopsies; this is decided by surgery/pulm/IR. Unless the patient has contraindications to RT or something like severe IPF (where treatment may be worse than the disease), I would likely offer th...
Do you typically recommend placement of a rectal spacer prior to definitive radiotherapy, regardless of dose/fractionation?
In my opinion, the potential and role of rectal spacing in minimizing toxicity is not debated. The concern about spacing relates to risks of the procedure and its associated additional cost to treatment may be greater than the potential improvement in toxicity for the patient. As we continue to show...
What options do you have when a patient has urinary obstruction during radiation treatment?
Here is my general practice on urinary symptom management for a man with prostate cancer undergoing RT.Urinary symptom management RT can decrease urinary symptoms in men with irritable urinary symptoms (Malik et al., PMID 20643513) - not sure of the mechanism, but it takes time to see the IPSS drop ...
Can RT to non-bulky sites be omitted in an early stage (stage I or II) classical Hodgkin's lymphoma case with a CR by PET/CT?
Randomized studies have consistently demonstrated that combined modality therapy is superior to chemotherapy alone in regards to progression-free survival in early-stage Hodgkin lymphoma. The magnitude of the benefit varies across studies, but a relative risk reduction of ~50% can be expected which ...
For resected oral cavity squamous cell carcinoma with indication for adjuvant radiotherapy to the primary tumor bed, would you routinely include ipsilateral and/or contralateral nodes even with a pN0 elective neck dissection?
Since the question states "routinely", the short answer is yes, but the longer answer is there is much more nuance to this.Some will say no based on Contreras et al., PMID 31246526.It is important though to recognize that this paper is a bit more complex and the details are critical.The question ref...
Is there any role for ctDNA testing after surgery or SBRT for Stage IB NSCLC to determine the need for adjuvant chemotherapy?
This is another emerging use for ctDNA that has shown promising results in small studies. The TRACERx consortium in the UK looked at the evolution of early NSCLC over time in 100 patients who underwent resection. They performed multi-region sampling and whole-exome sequencing and created patient-spe...
What are your top takeaways from ASCO GU 2026?
KEYNOTE-B15: Practice-changing study in mUC overturning prior SOC of several decades and establishing EVP as the new standard of care for patients with MIBC.RC48G001: Robust data for DV, a HER2-targeting ADC in treatment-refractory patients with mUC, supporting its use for a biomarker-defined patien...
Given the 10-year outcomes of UK FAST-Forward presented at ESTRO, how have you expanded the use of ultra-hypofractionation in your practice?
We offer 5 fractions to all early-stage breast cancer patients. If technically suitable, the preferred option is APBI; otherwise, FAST-Forward 26 Gy in 5, ensuring dose homogeneity as specified in the protocol.