Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Should regional nodes be included in whole breast RT for a favorable pT3N0 breast cancer after lumpectomy and SLNB?
I do not typically recommend RNI in a T3N0 following breast conserving surgery with negative SLN. While patient factors such as young age and pathologic factors ER-/Triple negative, LVSI concern me, they are not enough for me to offer RNI in a node negative patient.
How do you choose between neoadjuvant and adjuvant chemo-immunotherapy for patients with resectable stage II-IIIA NSCLC?
The billion dollar question. For patients with resectable stage II-IIIA NSCLC, how do you choose between neoadjuvant and adjuvant chemo-immunotherapy in light of the recent FDA approval of the CheckMate-816 regimen? Of course, this approval quickly followed in the footsteps of the FDA approval of at...
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.
Do TTFields work synergistically with SRS for patients with brain metastases?
Based on the presented data from the METIS trial, yes, TTFields works synergistically with SRS for patients with NSCLC brain metastases. It is not clear on the mechanism of action. It appears there is even greater synergy with use of ICI. One hypothesis is whether there is enhanced immune response, ...
Do you typically recommend placement of a rectal spacer prior to definitive radiotherapy, regardless of dose/fractionation?
In my opinion, the potential and role of rectal spacing in minimizing toxicity is not debated. The concern about spacing relates to risks of the procedure and its associated additional cost to treatment may be greater than the potential improvement in toxicity for the patient. As we continue to show...
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 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...
How do you approach post-lumpectomy surveillance in male breast cancer patients without BRCA or other mutations?
Annual mammograms, with additional sonogram if needed.
For a patient receiving postmastectomy IMRT to chest wall with expander and regional nodes including IMN, what constraint would you use for dose to the contralateral chest wall/implant if the patient also had a mastectomy and reconstruction on that side?
I use similar numbers and tend to accept a more generous approach to achieve coverage if the patient has undergone a contralateral mastectomy vs intact breast.
Have treatment recommendations changed for Stage I endometrial Cancer based upon PORTEC 4 results?
PORTEC-4a will almost certainly change recommendations for adjuvant treatment in high-intermediate risk stage I patients with endometrial cancer, and in at least 2 different ways, in my opinion. By following the molecular profiling guidelines, nearly half of these patients will avoid adjuvant treatm...