Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What would be your radiotherapy plan for an overall stage IIA, low-lying, MMRd rectal adenocarcinoma to try to avoid APR?
For an MMRd rectal cancer, I would use immunotherapy! Very promising data from MSKCC suggesting upwards of 100% clinical complete response with dostarlimab alone, without the need for RT!
Is there a role for stents for patients with a new diagnosis of metastatic upper rectal cancer with a near-obstructing primary?
I haven’t had much luck with stents - they hurt, they often migrate, and tumor growth or perforation is also a risk. My preferred approach is a diverting colostomy, then total neoadjuvant therapy, then resection with eventual ostomy takedown. (This assumes curative intent disease.) Of course, this d...
How do you manage persistent rectal bleeding in the setting of rectal adenocarcinoma in a treatment-naive patient?
For a locally advanced rectal adenocarcinoma in the era of TNT, treatment of the tumor with either chemoradiation or chemotherapy upfront is reasonable, and both choices are known to palliate colorectal cancers effectively. With more severe bleeding, we often consider starting with chemoradiation th...
When consolidating DLBCL with radiotherapy, do you treat all originally involved sites, or just initially bulky and partial responder sites?
When consolidating DLBCL with radiotherapy, several parameters must be taken into consideration. a) Is radiation therapy part of the treatment plan "on top" of full systemic treatment because of a certain risk situation due to not-optimal response of disease to systemic treatment (for example, FDG-a...
For adult intracranial (posterior fossa) ependymoma, how do you approach spinal cord constraints with planning to 54-59.4 Gy?
As you have realized, there is no way to keep SC to 54 with this prescription, and the more important point is: where does the radio-sensitivity of the brainstem transition to the spinal cord? After all, the distal brainstem is really a series organ as well. So, given that the control of disease is ...
What are your top takeaways from ASCO GU 2026?
I would highlight the NCI study of PSMA PET/CT monitoring of patients with biochemical relapse (Melissa Abel and Ravi Madan) and Johann de Bono's PSMA x CD3 bispecific.The NCI study is one of the most thought-provoking in terms of what PSMA PET/CT findings may really mean, since no one has done a na...
How do you sequence Pluvicto vs docetaxel in a fit, chemotherapy-naïve patient with high-volume PSMA-avid mCRPC progressing on an ARPI?
I generally favor starting with docetaxel, though both are reasonable options. CCTG Study PR21 did not show a difference in radiographic progression-free survival between starting with docetaxel versus starting with Pluvicto in this setting. However, OS favored patients who started with docetaxel, a...
Does a pathologic complete response in the breast and axilla change your radiation recommendations?
No. While it is tempting to assume that the chemotherapy has taken care of the local regional disease if there was a pathologic complete response (pCR), we do not yet have good assurance that this is the case. There is an ongoing randomized study testing this hypothesis in patients who have positive...
Would you consider adjuvant immunotherapy for a patient with high-risk Merkel cell carcinoma following definitive surgical resection and adjuvant radiation therapy?
Although there is no level 1 data supporting adjuvant RT in MCC, a relatively recent meta-analysis from an Italian group (Petrelli et al., PMID 31005218) showed that adjuvant RT is associated with a 75% reduction in local and locoregional relapses versus surgery alone, without a reduction in distant...
How would you treat a young breast cancer patient with limited nodal involvement and an isolated sternal oligometastasis at diagnosis?
Although there is limited data to support this approach, I have treated similar patients with "curative intent" with respect to the RT portion of their treatment. If the sternal oligomet is in close proximity to the ipsilateral IMNs, it can be included within the partial wide tangent fields for the ...