Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you manage refractory radiation cystitis status post pelvic EBRT/BT?
Thankfully chronic radiation cystitis and specifically radiation-induced hemorrhagic cystitis is relatively rare (2-8%) [1]. However, it can be a chronic and debilitating complication after pelvic radiotherapy. In managing these patients, first, I make sure to rule out another cause of cystitis – in...
How are you using ArteraAI in 2026 for intermediate risk patients?
I use both ArteraAI and Decipher to help with these decisions. As Dr. @Dr. First Last says, it's post-hoc based on large datasets. Artera claims to be predictive, while Decipher is just prognostic. Without going through all the data, I find it helpful for intermediate risk, where it is on the cusp o...
How do you approach treatment of a craniopharyngioma in an older adult patient?
There is a bimodal age distribution, with one peak in children between 5 and 14 years old and the second peak in adults between 50 and 75 years of age. Adamantinomatous (frequently with calcification) craniopharyngiomas are more common in children, while papillary (frequently lack calcification) cra...
How do you manage a T1N0 well differentiated anal margin squamous cell carcinoma with low-grade dysplasia at the surgical margin who has already undergone re-excision and is not eligible for further excision without an APR?
There is absolutely no role for the adjuvant treatment of carcinoma in situ or dysplasia in anal margin squamous cell carcinoma. The reasons for this are that 1) This is not cancer. The patient will live a long time. If you cause any long-term effects in a person who does not have cancer such as pai...
In patients with T1 anal squamous cell cancer status post local excision with a close margin, would you recommend close observation or adjuvant concurrent chemoradiation?
I would solicit the opinions of my colorectal surgery and GI colleagues to see if re-resection (with TAMIS, for example) is possible. If it is not, I would likely observe. If the margin was positive and not just close, I would do traditional chemoradiation.
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...
How does a pathological CR to neoadjuvant chemotherapy influence your practice for the use of bolus with adjuvant PMRT patients without inflammatory breast cancer, but who would meet traditional risk factors for skin involvement?
I would favor a bolus for the first half of treatment.
Do you offer adjuvant radiation therapy for patients with hepatocellular carcinoma status post partial hepatectomy with positive parenchymal margins?
The answer to this question had changed in my mind with the advent of ablative doses and techniques. If the postop scan does not show bowel near the area that you estimate to be at risk, I would observe and offer an ablative dose if there was an isolated recurrence. The competing risks of DM and liv...
Is pre-treatment nodal ultrasound evaluation necessary if a patient undergoes upfront PET/CT for staging?
The answer to this question depends greatly on the local capabilities to conduct regional nodal ultrasound. If this can be done, then we find ultrasound to be very helpful. In today’s environment, it is difficult to obtain insurance approval for PET in the staging of node-positive breast cancer. Bey...
Would you treat the axilla and supraclav in a recurrent breast cancer that presented in the breast and IMNs that had comprehensive breast/node radiation many years ago?
Not for prophylaxis -the risk of complications is too high. I would reserve RT for treatment of symptomatic lesions not otherwise manageable by surgery or systemic therapy.