Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage a patient less than 40 years old with an incidentally found LGG, IDH mutated, 1p19q intact, s/p STR?
Update: On August 6, 2024, the FDA approved Vorasidenib for IDH-mutant low-grade gliomas based on findings from the INDIGO trial. This decision highlights the FDA's incompetence and lack of scientific integrity, clearly demonstrating that the agency prioritizes pharmaceutical companies' interests ov...
What experience do you have with paralysis or myasthenia-like symptoms developing on temozolomide?
I have not had a patient with this adverse effect. Mechanistically, I am not sure how this would be explained by the drug. I would recommend a workup for other contributing factors. I was unable to find any reports in the literature of TMZ-induced MG.
What "normal brain - PTV" dose constraint would you recommend for a large solitary cerebellar metastasis, planning 3 or 5 fraction SRT?
There are two relevant studies that I utilize for relevant planning considerations: HyTEC (which examined data from 51 reports for NCTP modeling for 1-, 3-, and 5-fractions) as well as Upadhyay et al. (which examined outcomes from a high-volume single-institution center where 3 fractions is their 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...
Are any centers routinely using 55 Gy in 20 fractions with chemotherapy for definitive treatment of head and neck cancer following presentation of the HYPNO study?
I would not consider 55 Gy in 20 fractions a standard approach. The comparator arm was not standard practice in the US (66 Gy in 33 fractions with 5 weekly cycles of cisplatin at 35 mg/m2). Both the total RT dose (66 Gy < 70 Gy) and the total cisplatin dose (cumulative dose 175 mg/m2, less than the ...
How does the presence of indeterminate lymphadenopathy on PSMA PET scan alter your management of unfavorable intermediate-risk prostate cancer?
Summary: In practice, I usually review the imaging myself and attempt to evaluate for common pitfalls of interpretation or evidence that may convince me of a true positive. Often, I find a second review by a blinded radiologist helpful. Unless I am highly suspicious of a false positive, I often err ...
What are your top takeaways in Cutaneous Malignancies from ASCO 2026?
I presented a phase II trial of neoadjuvant cemiplimab immunotherapy and response-adapted radiotherapy for patients with locally advanced, unresectable cutaneous squamous cell carcinoma. Historically, the 2-year progression-free survival (PFS) rate in this situation with radiotherapy with or without...
Would you offer PMRT to a patient with pTisN1a left breast DCIS?
Macrometastases suggest there is missed invasive disease in the midst of 11-cm DCIS. For one macromet with only SLNB done, I would add CW and RNI as part of treatment, but if I had an ALND, then RT can be avoided.
Would you offer radiation therapy for stage IV pancreatic adenocarcinoma with liver metastases after 12 cycles of FOLFIRINOX and maintenance capecitabine, now with locally progressive disease at the pancreatic primary and rising CA 19-9?
Although not stated in the question, I assume this is a situation in which the liver metastases appear to be responding to chemotherapy with a radiographic partial response or stable disease. If the patient were progressing in both the liver and the pancreas, the next step in management would most l...
Is radiation therapy a treatment option for refractory Paget's disease of the vulva extending onto skin of buttocks and anal margin?
I have treated localized peri-anal Paget's Disease with good outcomes, and there is some data to support this. I have not treated a patient with such widespread vulvar Paget's and I suspect that the morbidity would be significant given the doses required, and the volume to be treated in the case you...