Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you treat non-spine bone oligometastases?
Get the MRI. It is proven to reduce inter-observer variability in contouring (Raman et al., PMID 29748100). More philosophically, sometimes you'll see something more, sometimes you won't. But the only way to know is to check. And if this treatment is worth doing, it's worth doing accurately -- espe...
When discussing definitive prostate radiation, how do you respond to patients who mention that they heard that surgery is more difficult after radiation treatment?
I love this question! I hear it quite often, and it provides an opportunity to discuss the differences between radiation and prostatectomy, and the potential benefits and risks of both. I start by stating that it is absolutely true that radiation causes scar tissue that can make surgery months to y...
In pediatric patients with Hodgkin lymphoma who have a partial response after chemotherapy and multiple disease sites above and below the diaphragm, how do you approach radiotherapy planning considering cumulative dose and toxicity?
RT dose and target volume in pediatric Hodgkin lymphoma are determined according to the systemic therapy protocol being used. For example, your case suggests a patient with Stage III or IV disease. In the COG study AHOD1331, patients received either Bv-AVE-PC or ABVE-PC systemic therapy x 5 cycles a...
What areas do you treat with RT for an intermediate or high risk pediatric Hodgkin Lymphoma with a slow early response?
For pediatric Hodgkin lymphoma, radiation fields are really based according to the treatment protocol. If the patient was being treated per AHOD 0031, then the radiation fields would include all sites of initial involvement, assuming they don't meet the criteria for omission of RT (RER and then a CR...
Does micropapillary subtype for a G1-2 DCIS affect your radiation treatment recommendations?
It doesn’t change the recommendation. If adequate, imaging and surgery are done, like any other DCIS.
Do you use liver SBRT to areas previously treated with Y90 and subsequently failed?
Prior Y90 is a risk factor for liver decompensation that's hard to quantify. If there is relatively low volume disease and I am retreating with complete overlap of the prior TARE, I don't think there isn't any increased risk with retreatment. If the TARE went to more than 1-2 segments, I would be co...
What are your top takeaways in Medical Oncology from SABCS 2025?
lidERA trial. This is the first phase III trial showing an advantage for an oral SERD giredestrant over standard endocrine adjuvant therapy in early breast cancer. Treatment with giredestrant led to a 30% reduction in the risk of invasive disease recurrence over standard endocrine therapy at the fir...
Does the presence of perineural invasion on a prostate biopsy change your management decision?
I would consider perineural invasion as one of the "soft" criteria that may help impact treatment decisions. Previously this would have also included such things as Gleason 3+4 vs. 4+3, Gleason 8 vs. 9-10, or the percentage of positive cores. However, as these factors have now been included in the A...
How do you interpret isolated PSMA-avid sites in a patient with prostate cancer with no pelvic or RP LN uptake?
The issue of false-positive PSMA scans is a vexed one, and we are still learning how to handle this optimally. My general approach is to think about the clinical context, level of risk, and whether an early diagnostic pick-up will actually make a clinical difference. For example, in a patient with ...
Do you modify dosing and monitoring of Lu-177–PSMA therapy for patients with prior large-field RT involving substantial active marrow compared with patients who only had focal bone SBRT?
No, we do not modify dosing and monitoring of PSMA therapy with prior large-field RT. In the VISION trial, the vast majority of patients were heavily pre-treated, presumably many with pelvic radiation for definitive treatment or treatment for bCR prior to metastasis. Assuming that the patient had ap...