Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you approach adjuvant radiation recommendations for low-risk endometrial cancer in which the patient was unable to undergo pelvic sentinel node mapping?
Nodal assessment would not change much for me, as it’s a low-risk disease, and PORTEC data have shown the risk of nodal recurrence is low. For focal LVSI, one may consider brachy alone.
What criteria are you using for retreatment with Pluvicto (Lu-177) in those who maintain a good performance status and appropriate lab work?
Mainly, whether or not they've exhausted standard options. At the time I'm answering this, Pluvicto is approved for castration-resistant metastatic disease, either pre- or post-taxane chemotherapy. If they have not had chemo, I usually recommend it. If they have, I get their medical oncologist to we...
Would you consider utilizing pembrolizumab/enfortumab as a bladder preservation approach in patients with MIBC?
Yes, I think that this is a viable approach. Data from perioperative trials, including KN-905 and EV-304, suggest very high rates of pathologic complete responses in almost two-thirds of all patients at the time of radical cystectomy. Many of these patients may not need radical cystectomy for an opt...
Would you irradiate elective lymph nodes for a T1 Merkel cell carcinoma of the head and neck with a negative sentinel lymph node?
In general, I would not irradiate due to the negative sentinel lymph node biopsy (SLNBx). Either one trusts the prognostication of a SNLBx and obtains one, or not. If one does not trust the process of SLNBx, then you should not obtain one and electively treat. I do not see the utility in obtaining a...
Would you recommend sentinel lymph node biopsy at the time of wide excision for a 3 mm Merkel cell carcinoma of the cheek/lateral canthus?
Unlike melanoma and certainly NMSC, MCC is highly unpredictable in nature, with clinical lesion size having little clinical prognostic value. As such, it appears that SLNB is valuable in many cases for the purposes of prognosis and in determining the need for adjuvant systemic therapy and radiation....
Would you consider ultra-hypofractionated 5 fraction regional nodal radiation in a node + breast cancer who otherwise wouldn't tolerate 16 fractions of RT?
At this time, unless there was a strong reason that hypofractionated breast + RNI in 15-16 fractions couldn't be done, I wouldn't use 5 fx breast + RNI off-trial. If compelling reasons, one could consider extrapolating safety of breast RT from FAST/FAST-Forward and axilla from melanoma data.
Do you offer consolidative radiation for oligometastatic breast cancer?
I'd like to add a few additional considerations to the already excellent responses from our colleagues. Many of the trials cited actually address two related but distinct clinical questions, and the answer for HER2-positive disease specifically may diverge from the population-level results.Trials of...
What are the treatment options for a patient with unfavorable intermediate risk PCa who desires future child bearing?
The best option for such patients would be sperm banking prior to treatment, whether they undergo RT+ADT or surgery. See this prior post on this forum regarding the impact of RT on fertility. Given the expected internal scatter dose to the testes during a course of fractionated RT, it would not be s...
How would you treat an elderly patient with metastatic breast cancer with two new progressive right breast/chest wall lesions?
I addressed the question of how to manage patients with symptomatic breast masses in a posting on December 19, 2025. The first question for this patient with progressive lesions is whether they are symptomatic now or not. If not currently symptomatic, then I would likely defer RT until such time as ...
How do you check surface dose when treating post-mastectomy patients with radiation?
We have stopped using bolus except for T4b disease, dermal involvement, or extensive LVSI, pathologic dermal involvement, or positive margins. In cases where we use bolus check with in vivo dosimetry and aim for 90% or above dose. Another situation where a bolus may be used is in a very thin chest w...