Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you offer PMRT to a patient with pTisN1a left breast DCIS?
Macrometastases suggest there is missed invasive disease in the midst of 11-cm DCIS. For one macromet with only SLNB done, I would add CW and RNI as part of treatment, but if I had an ALND, then RT can be avoided.
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...
What SBRT dose would you give to a single external iliac lymph node recurrence (1 cm size) for a patient previously treated with salvage radiation to the pelvis?
35 Gy/5 is fairly safe in the re-irradiation setting, and in our experience, it's quite effective for nodal disease.
When do you recommend post-operative radiation therapy for extracranial chondrosarcoma?
When an en bloc resection with negative surgical margins is not achieved. Typically, this means tumors of the axial rather than appendicular skeleton, as margins are typically wide in the latter. There is "oncolore" that chondrosarcomas are radioresistant tumors. This is likely true at lower pallia...
Do you typically incorporate radiotherapy into the management of extraskeletal myxoid chondrosarcoma?
Yes. RT appears to be quite effective in improving LC for chondrosarcomas, including extraskeletal myxoids. This is likely to be particularly relevant where wide margins cannot be obtained (e.g., spine, pelvis, joints).The benefit of RT (HR 0.27 for LF) was nicely shown in a recent large, well-condu...
In light of Aizer et al. data presented at ASCO 2025, what is your threshold for offering SRS/SRT in patients with multiple brain metastases?
Over the past 4 decades, the treatment of brain metastases has been evolving along with advances in technology, from simple whole brain radiation (WBRT) with opposed lateral fields to IMRT-driven treatment (HA-WBRT); similarly, in the field of SRS/SRT, we have pushed the envelope of what we can achi...
Has the recent SBRT vs HDR monotherapy analysis changed your use of HDR monotherapy for intermediate-risk prostate cancer?
With excellent outcomes with SBRT in this group (PACE-B), the additional advantage of brachy is limited. The predominant use of HDR brachy is either as a boost for high-risk or as salvage after previous EBRT.
When evaluating margin status to consider APBI for early stage invasive breast cancer, given the specification for at least 2 mm margins, do you look at the DCIS margin or only the invasive margin?
I take a slightly different approach. Current guidelines for breast conserving surgery allow for no tumor on ink for invasive cancers, even those with DCIS associated. While ASTRO guidelines recommend 2 mm for APBI (Correa et al., PMID 27866865), other guidelines such as the ABS do not for invasive ...
How would you approach a patient with invasive breast cancer and DCIS s/p mastectomy and immediate reconstruction with a negative invasive margin, but a close DCIS margins?
I would observe such a patient. With a close DCIS margin post mastectomy, there is very little evidence of a benefit to PMRT. Subsequent local recurrence is well below 10% so I see no clear role for PMRT in such a case. Even if there was a close invasive margin unless there were other aggressive fac...
How does a close DCIS margin factor into surgical and radiation decision making for Stage I invasive ductal carcinoma after breast conserving surgery?
Based on SSO and ASTRO guidelines for invasive tumor, no tumor at inked margin is considered negative by us for suitability for adjuvant RT. If there was calcification as part of the mammographic finding, then for close DCIS we would look at the specimen radiograph and also consider pre-RT mammogra...