Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you conduct follow-up on patients with brain mets who have undergone GammaTile placement?
For patients with high-grade gliomas, they get an immediate post-implant CT and MRI for dose calculation, then I schedule serial follow up CE-MRI every 9-10 weeks for at least a year; if stable at the one-year mark, I "graduate" the patient to get MRIs every 12 weeks for the second year of follow-up...
How would you manage a rare presentation of an older adult after gross total resection of an "infant-type hemispheric glioma" of the left frontal lobe, IDH1 negative and negative for MYB fusions?
Infant-type hemispheric gliomas (IHGs) are rare high-grade astrocytic tumors characterized by giant size and abundant vascularity, often with regions of cystic transformation. They are aggressive brain tumors that occur during early infancy, usually between 0 and 12 months of age. They are often ver...
For a patient with large volume glioblastoma, what do you do if they are found to have a subdural infection in the middle of chemoRT requiring repeat surgery?
In this scenario, the patient will likely stop the daily treatments for a variable period of time that I would estimate to be measured in weeks while recuperating from surgery and receiving IV antibiotics. When cleared for radiation, I would start by doing a new Simulation using an updated MRI to ac...
For mCRPC patients who are eligible for both, how do you decide between Enzalutamide+Rad223 (EORTC 1333/PEACE-3) or Enzalutamide+Lu-PSMA-617 (ENZA-p)?
While both these studies addressed interesting questions, both enrolled patients who were ARPI-naive. We are in an era where ADT intensification is the standard of care, and hopefully, we will see an even smaller number of folks with mCRPC who would look like the patients enrolled in both these stud...
In a patient with biochemical recurrence after radical prostatectomy for pT2 disease and a high-risk Decipher genomic classifier, with a PSA of 0.7 ng/mL, is there a rationale for administering salvage radiation therapy to the prostate fossa?
Yes, salvage RT to the prostate fossa (+ ADT/ pelvic lymph nodes) would be considered the preferred option in this circumstance, in my opinion (see NCCN 2026.3). Despite the PSA being higher than is typical in 2026 and some risk factors for not responding to RT (e.g., margin-negative resection), it ...
Does the presence of an ATM mutation impact your fractionation regimen for a woman with breast cancer?
ATM mutation is not a contraindication for RT. Techniques should be used to reduce scatter dose to contralateral breast. This is very good review on the topic.https://www.ncbi.nlm.nih.gov/pubmed/31381960
Is it acceptable to treat newly diagnosed small cell lung cancer with limited brain metastasis with upfront SRS?
First, to be clear, there's not good evidence regarding the role of radiosurgery in small cell patients who have not had WBRT or PCI. In patients without brain metastases, there's a clearly defined and clinically significant survival benefit, which seems to result from both control of existing metas...
How would you treat a patient with osteoarthritis of just one joint of the hand?
People do this in various ways - some people treat the joint with a large margin, others may treat the whole hand.I originally started by treating the affected joint, but pretty soon I after I switched and started treating the whole hand - pain is subjective and though it may appear localized, there...
Do you offer low-dose radiation therapy for osteoarthritis of the spine?
DEGRO has published guidelines on this very topic, so I would respectfully disagree with a comment arguing a lack of data. Of course, if one is looking for level 1 data on irradiating benign diseases in general, there may be little to satisfy.That being said, there's no level 1 data espousing the be...
What dose and treatment area of radiation should be given when p16+/HPV ISH negative SCC is found in the scar of a level V lymph node excisional biopsy with all other workup negative?
It is difficult to give a detailed and nuanced response in one sentence. I would double-check that this is also EBER-negative, and if so, I would suspect a non-HN mucosal primary, possibly skin (as these can be p16+ve HPV -ve). As such, I would focus treatment on the involved neck. It sounds like, d...