Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Are there any scenarios in which you would offer SBRT as your preferred treatment approach for appropriate candidates with intermediate risk prostate cancer?
Based upon the PACE-B trial, 40 Gray to the prostate, 36.25 to the PTV, which was compared to standard or moderately hypofractionated radiation, and documented non-inferiority. It is reasonable to consider stereotactic radiation therapy as a standard of care for intermediate-risk prostate cancer. If...
In which patients do you utilize a breast MRI as part of the initial workup for breast cancer?
I'm not a fan of routine MRI in the work-up for early-stage breast cancer, but I do agree with the fairly standard list of selective indications mentioned previously. I also obtain an MRI when there is a significant discrepancy between standard imaging and physical exam. Examples would be: One or a...
How do you manage a symptomatic primary breast tumor in a patient with metastatic disease?
It’s much harder to treat patients palliatively than to cure. The art of palliation generally requires weighing the acute and subacute toxicities of alternative treatments much more heavily and chronic toxicities less than we do for potentially curative care. It also requires assessing whether patie...
Would you consider radiation alone or chemoradiation therapy for a small vulvar cancer near the urethra or clitoris?
Yes, I think radiation is worth considering in this situation. However, the morbidity of radiation is also significant with potential for edema and fibrosis in high dose volume. The consequence of that may arguably be worse than surgery. If we do treat with radiation, I would still add chemotherapy ...
Does delay to the time of lumpectomy impact your decision to omit radiation?
There seem to be two issues to consider in this situation. One is whether patients undergoing neoadjuvant endocrine therapy, then lumpectomy without RT, have an acceptable local recurrence rate. The only study I know of directly addressing this issue was presented at a poster session of the 2017 San...
How do you approach breast hypofractionation RNI with the results of the Skagen Trial 1?
There are multiple prospective/randomized studies showing non-inferiority for complications or cancer outcome with hypofractionation and RNI, including Wang et al., PMID 30711522, HypoG-01, FABREC, RT-CHARM, and the subset arm of STARTb. The primary endpoint of DKSG was also lymphedema, which was no...
Do you offer consolidative radiation for oligometastatic breast cancer?
Not routinely, as prospective randomized trials have not shown any survival advantage.
Are there situations in which you would definitely recommend radiation in an elderly patient with ER+, early stage breast cancer?
I always have a little trepidation in answering questions whereby I would “definitely†recommend any therapeutic path as clinical decision making needs to be a bit more nuanced. Every situation requires a careful weighing of multiple inputs including clinical trial data and patient-specific fact...
What are your top takeaways in Neuro Oncology from ASCO 2025?
Aizer et al., JCO 2025 - A multi-instituitional Brigham Dana-Farber-led trial randomized 196 patients with 5-20 brain metastases to stereotactic radiosurgery (SRS) or hippocampal avoidance whole brain radiotherapy (HA-WBRT). Patients treated on the SRS arm had significantly less symptom burden, wit...
Do you recommend IM biopsy in the initial staging of breast cancer patients with suspicious IM nodes on imaging?
I think it is always preferable to biopsy suspected cancer sites when developing a therapeutic plan. Biopsy provides a greater degree of certainty in clinical decision making and can be informative when evaluating outcomes of care retrospectively for quality improvement or research projects. However...