Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you treat an isolated urothelial cancer local recurrence abutting the duodenum?
My first question would be "why not surgery?" This would be my preferred approach unless there is some contradiction to surgery that I am unaware of. If surgery is contraindicated, I would use a conventionally fractionated approach and try to get to a dose of 5,940 cGy, but this would be following a...
What evidence supports the use of high tangents for pN1mic breast cancer?
This is a great question. To add to the excellent answers from @Dr. First Last and @Dr. First Last, here are some of my thoughts on this topic:At the time of MA.20, the size of nodal metastasis was not routinely measured so it is unclear what percent of patients in MA.20, if any, had micrometastases...
What are your top takeaways in Head & Neck Cancers from ASCO 2026?
The study by Nair et al., ASCO 2026 (AREST), will be quite intriguing when published. First and foremost, there will hopefully be a better definition of the irradiated “at-risk neck nodal region” in these patients who only underwent ipsilateral NDs. Probably the buccal patients had ipsilateral radia...
What fractionation would you use for a young patient with a schwannoma that has regrown within 2 years of resection?
This is a complex scenario given the 2-year time interval for progression in conjunction with a Ki-67 up to 30%. It is not clear within the question whether initial resection was gross total or subtotal and whether the diagnosis of cellular schwannoma and its focally very high Ki-67 index were reach...
What is your radiotherapy fractionation recommendation for favorable intermediate risk prostate cancer who has ~70 cc prostate?
This may seem controversial in 2026 and seems to contradict evidence, but I just wanted to relay what I've seen. I was a fairly early adopter of moderate hypo-fractionation, not the first, but not the last - probably around 2012-2013. I pretty much changed to that for all patients for around 11-12 y...
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...
What is your preferred comprehensive nodal irradiation approach in non-metastatic breast cancer patients with underlying respiratory diseases or poor baseline respiratory function in light of the findings from the RadComp Trial?
The RadComp trial PRO-CTCAE item for no shortness of breath versus any shortness of breath significantly favored protons as reported in the abstract. However, after correction for multiplicity, this became non-significant, meaning there was no difference. While multiplicity analyses ensure that fals...
What proton dose regimen would you use for locally recurrent esophageal cancer previously treated with chemoRT?
Like @Dr. First Last, I would also somewhat challenge the premise of the question. Typically, the dose-limiting structure for re-irradiating esophageal cancer is the esophagus itself, so protons do not offer an inherent advantage in this case. Protons may still be reasonable to reduce lung or heart ...
In your practice, what is your goal dose for boosting positive PA nodes in either the adjuvant or definitive treatment for cervical cancer?
The dose of RT is based on the risk of tumor recurrence tempered by normal tissue constraints. In general, known or suspected gross nodal disease is treated to 60 Gy; higher doses of 62-66 Gy may be used for large nodes that are not immediately adjacent to the duodenum, particularly if a portion of ...
How would you define the role for radiation in the management of a primary vulvar leiomyosarcoma in close proximity to anus?
in the absence of significant data -it is reasonable to offer postoperative RT after surgical resection unless surgery is impossible due to invasion of anus