Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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...
Should axillary imaging be routinely performed in all patients with a new diagnosis of breast cancer?
This issue has been debated but I would argue that patients with a new diagnosis of breast cancer should not undergo routine screening US of the axilla to look for clinically occult disease. The axillary US should be limited to diagnostic imaging for clinically suspicious nodes on clinical exam or b...
What treatment sequence do you follow for patients with rectal cancer who are candidates for both PROSPECT and TNT/Watch and wait?
Thanks for this question. I am not sure whether this is up to us. This is up to our patients to choose which modality they would like to omit (radiation vs surgery). I would point out that a good quality MRI rectum should be performed to r/o any T4/N2 disease or potential requirement for APR. Otherw...
Is there an "ideal" method for abdominal motion control when treating upper abdomen malignancies?
When using doses that potentially exceed OAR tolerance (specifically luminal GI,common and main bile ducts, liver) in the upper abdomen it is important to not only have a solution for organ motion, but some form of high quality image guidance. When giving a BED of <60 Gy, there is no need to use the...
How would the updated results of ECOG 3311 influence your adjuvant RT recommendations for HPV+ OPSCC?
This question refers to this manuscript (Burtness et al., PMID 40493877), which is a 4.5-year follow-up of ECOG E3311.The results broadly mirror those seen in previous reports. The most notable novel finding reported is that among patients with low-risk features (who did not get any adjuvant RT), th...