Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What are the current official guidelines regarding managing patients during COVID-19?
Here are some guidelines and FAQ from professional societies: NCCN: https://www.nccn.org/covid-19/default.aspx ASTRO FAQ: https://www.astro.org/Daily-Practice/COVID-19-Recommendations-and-Information/COVID-19-FAQs ASCO Coronavirus Resources: https://www.asco.org/asco-coronavirus-information
How will your management of head and neck cancers change with the COVID-19 pandemic?
Short answer: Most head and neck cancer radiation is as necessary as it gets. At this point, my management won't change very much. That may change as the pandemic evolves. Use all the appropriate precautions to stop the spread of COVID-19 and other viruses (we are using masks for every staff member,...
Would you consider the thymus as an OAR during treatment planning for advanced NSCLC?
With any avoidance, the dose is pushed further somewhere else, with often unclear effects. You really can rob Peter to pay Paul. I reckon that, as automated, AI-guided OAR contouring occurs, many substructures can be feasibly and reliably drawn and then monitored for associated late effects. It is g...
What criteria do you use in deciding whether or not to treat the pelvis in prostate cancer?
NRG/RTOG 0924 - The end of elective nodal RT in localized prostate cancer? Top line results: NRG/RTOG 0924 is a very large phase III randomized trial powered for overall survival (OS) to determine if there is a benefit of the addition of whole pelvic radiotherapy (WPRT) to prostate RT plus ADT. This...
What do you tell patients that opt for High-intensity focused ultrasound (HIFU) for favorable intermediate risk prostate cancer over AS (Active Surveillance), RP (Radical Prostatectomy), EBRT (External Beam Radiation Therapy), or brachy?
Urology and radoncs differ in their approach to this. Recent (inflammatory) social media discussions have shown this. There are limited prospective data on focal therapies versus whole-gland approaches, but the retrospective data should give us all pause. What we do know: HIFU has significant toxic...
In a patient with locally advanced rectal cancer, T3N1, who has undergone diverting sigmoid colostomy due to symptomatic obstruction, when do you start radiation following surgery?
Typically, the blind end of the sigmoid colon can be avoided, especially with IMRT. In general, the surgeon should understand that and should not leave it in your volume. As long as that is the case, you can start as soon as the patient feels well enough for treatment positioning (upon discharge, ev...
Do you routinely recommend prophylactic cranial irradiation for stage I small-cell lung cancers treated with lobectomy and adjuvant chemotherapy?
PCI was 'associated' with better long-term survival even in stage 1, and age and size factors do not seem to matter. However, as the information gets divided, fewer patients fall into each cohort.A recent study published in the JCO, analyzing over 1,000 patients in the NCDB, found that thoracic radi...
How do you approach a locally recurrent prostate cancer after prior cryotherapy salvage and external beam?
These are tough cases and ones where multidisciplinary tumor boards are really helpful. For all these men, I recommend a PSMA PET as well as mpMRI and confirmatory biopsy. Want to be as certain as possible that we're dealing with a local-only recurrence.Additionally, overall prognosis matters. If lo...
In patients with concomitantly diagnosed stage IV DLBCL and gastric MALT lymphoma who have residual gastric MALT after 6 cycles of Pola-R-CHP, would you alter the standard dose/fractionation for ISRT for the gastric MALT lymphoma?
Chemoimmunotherapy, while potentially curable for aggressive non-Hodgkin lymphomas such as DLBCL, is not generally considered a curative treatment for low-grade histologies, such as follicular and marginal zone lymphoma. After completing appropriate therapy for the more aggressive histology (DLBCL),...
How would you treat perineural recurrence of a cutaneous squamous cell carcinoma after initial electron XRT (55 Gy/20 fractions) to the primary site given 1.5 years ago?
An unfortunate but not too uncommon situation. Assuming no other sites of disease, it is a curable condition. Explore immunotherapy first ,with cemiplimab but would need RT eventually to cure - see RAMPART study with promising results presented by Dr. @Dr. First Last at ASCO 2026. RT parameters: tre...