Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you recommend placement of a rectal spacer when delivering radiotherapy to the prostate in patients with oligometastatic prostate cancer?
No. I have had a few patients seek it out on their own, which is fine. But I tell them it is not necessary.
Given the recently published results of PEACE 2, under what scenario would you offer pelvic radiotherapy for high-risk/very high-risk prostate cancer?
Although PEACE-2 was presented at GU ASCO, to my knowledge it has not yet been published other than in abstract form, and the results of the arms in PEACE-2 comparing prostate only vs whole pelvic RT were not presented, so I don't think PEACE-2 sheds any light yet on the question of whether or not t...
For a patient with metastatic, poorly differentiated esophageal adenocarcinoma with an excellent systemic response to chemotherapy for 1 year, who now presents with isolated local progression and no new distant disease, would you consider treating the primary site with a higher palliative RT dose for more durable control?
For genuine oligoprogression limited to the primary tumor, in a patient who is otherwise fit and responding to systemic therapy at distant sites for ≥1 year, I would definitely consider a higher RT dose aimed at durable local control, not just short-term symptom relief. The exact regimen would obvio...
For consideration of empiric lung SBRT without pathology, do you use a preferred nomogram to guide this decision?
I feel most comfortable offering empiric SBRT when the following criteria are met: Growing PET avid Not likely a non-malignant condition Compelling medical or patient-specific reason for no biopsy Patient understands the implications of proceeding without a biopsy
Do you treat adenocarcinoma in situ (AIS) or minimally invasive adenocarcinoma (MIA) of the lung with SBRT in medically inoperable patients?
The literature on this for SBRT is quite thin. We looked at our institutional experience a few years ago using SBRT for MIA/AIS. You'll have to excuse the onerous title. It was published right around when we started switching away from the term BAC, and we wanted to make sure folks could find it!We...
Would you wait to treat a ground glass opacity lesion (minimally invasive adenocarcinoma or adenocarcnioma in situ) with SBRT until there is more of a solid component?
In general, it is understood that the appropriate indication for utilizing lung SBRT is in the setting of a diagnosis of invasive cancer, i.e., early stage lung cancer or an oligometastatic lesion. With regard to ground glass opacities (GGOs) it is understood that the differential for these entities...
How does the POSEIDON meta-analysis results influence your decision on which patients should receive hormone therapy with post-operative radiotherapy for recurrent prostate cancer?
POSEIDON is another landmark analysis from the MARCAP consortium. It adds to the seminal work performed in localized prostate cancer (Kishan et al., PMID 35051385), which serves as the reference study for the use and duration of ADT with radiotherapy, but now in the post-prostatectomy setting.The st...
Does the possibility of future Lu-177–PSMA therapy change your current threshold to offer earlier metastasis-directed RT in oligometastatic prostate cancer?
There is a lot of excellent research being done on the efficacy and tolerance of combined Lu-177-PSMA therapy and EBRT. So far, the combination is well tolerated, and there is some data that sequencing the two to allow EBRT to treat the more “Pluvicto-resistant” lesions may help with efficacy.The qu...
What is your preferred approach in a patient unable to fill their bladder during prostate radiotherapy?
If a patient is willing to do a penile clamp or foley, then sure, go for it. Some patients want to 'do everything' and either is reasonable. Whether or not they need to is another question. Most Grade 3+ GU toxicity is either hemorrhage or stricture. Unfortunately, there isn't great data for any con...
What are your top takeaways from ASCO GU 2025?
In terms of practice-informing presentations in prostate cancer here are my top 3: GROUQ-PCS 9 trial (Canada, abstract 22). This trial led by Niazi et al tested whether metastasis-directed radiotherapy based on conventional imaging to up to 5 sites provided benefits in delaying rPFS or PSA progressi...