Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What strategies do you use for dose escalation when irradiating patients with inflammatory breast cancer?
I usually treat with conventional 2Gy to 25 fractions followed by 10 gy boost to scar area. In patients with a poor response to chemo, consider increasing the boost to 16 Gy. If they have any prechemo nodes like IM node or supraclav nodes, then boost the involoved node to higher total dose of 56 to ...
In what clinical situations do you order NavDx?
At MSKCC, we largely use NavDx as part of our post-operative de-escalation trial in which NavDx is checked pre and post surgery to help select patients for de-escalation. If NavDx becomes undetectable after surgery: In patients with pathologic risk factors that warrant adjuvant RT, patients undergo...
Do you consent patients for diabetes insipidus following SRS or fractionated radiation for pituitary tumors?
This, and more broadly hypopituitarism of any type, is an important consideration and likely under-addressed topic in consent.Untreated hypopituitarism in adult life is associated with reduced all-cause life expectancy, and by one study 2x mortality rate compared with age/sex matched controls. [1]Th...
What SBRT dose and constraints would you use for a primary endobronchial NSCLC that is too thick for brachytherapy?
It really depends on the size and location of the lesion with respect to the proximal bronchial tree and other mediastinal structures (such as the esophagus). SBRT, as commonly understood (e.g., 50 Gy in 5 fractions), strikes me as risky in most such scenarios. Something more like 60 Gy in 15 fracti...
How would you treat node positive (pN+) prostate cancer with undetectable post-op PSA after radical prostatectomy and pelvic LND?
The short answer is, YES I would, in general, recommend treatment. I also respectfully disagree that ADT monotherapy is the standard of care. It is an option of course, but rarely performed given it is non-curative and the data to support its use is of minimal relevance today.Some key points of reas...
What are your top takeaways from ASCO GU 2026?
KEYNOTE-B15: Practice-changing study in mUC overturning prior SOC of several decades and establishing EVP as the new standard of care for patients with MIBC.RC48G001: Robust data for DV, a HER2-targeting ADC in treatment-refractory patients with mUC, supporting its use for a biomarker-defined patien...
Do you favor MRI-guided adaptive SBRT over conventional SBRT when baseline urinary symptoms raise concern for toxicity in a patient with localized prostate cancer?
Most trials of SBRT for prostate cancer had exclusion criteria based on baseline urinary symptoms. These vary somewhat from trial to trial, but if your patient is outside of the moderate range on the IPSS score, you may want to consider an alternative to SBRT. Also, the only randomized trial of whic...
How do you choose between neoadjuvant and adjuvant chemo-immunotherapy for patients with resectable stage II-IIIA NSCLC?
The billion dollar question. For patients with resectable stage II-IIIA NSCLC, how do you choose between neoadjuvant and adjuvant chemo-immunotherapy in light of the recent FDA approval of the CheckMate-816 regimen? Of course, this approval quickly followed in the footsteps of the FDA approval of at...
Do you still offer adjuvant chemotherapy and chemoradiation for NSCLC after neoadjuvant chemoimmunotherapy?
In the pre-neoadjuvant era, the options for patients who had R1 (positive margin) or R2 (gross residual disease) were: re-resection followed by adjuvant chemo; sequential adjuvant chemo followed by radiation; or concurrent chemoradiation. There is retrospective data suggesting a survival benefit fro...
For post-prostatectomy radiation, are there any special considerations if there is a bladder sling or artificial urinary sphincter?
Radiation after a bladder sling or a urinary sphincter can be done, and in my experience is mostly done without major complications. I have done it several times, and I am not aware of any significant problems. There are no prospective studies or randomized studies of which I am aware that can help ...