Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is it appropriate to use SBRT on unresectable pancreatic tumors invading the duodenum?
Duodenal invasion would be considered an absolute contraindication to SBRT at our institution. If you look at the early SBRT experiences, such as the Danish phase II trial (PMID 15990186) which treated with larger margins than we use today and did not pay as close attention to the duodenal dose, the...
What normal tissue constraints do you use when treating a palliative head and neck patient with the Quad Shot?
Great practical question. The constraint mentioned in the question is only for 8 fractions and the goal is to get the patient to all 12. Keep in mind that most of the published series used 3D technique with IMRT being used in the tail end of the patient series. I have used BED calculations to conve...
How would you manage T3N0M0 sarcomatoid carcinoma of the prostate with adenosquamous differentiation s/p prostatectomy?
Sarcomatoid prostate cancer is an aggressive histological subtype. It may be locally aggressive, and post-operative PSA monitoring may be less helpful for this histologic subtype, which interferes with the usual trigger for initiation of salvage RT (Grignon, PMID 14976541). Despite the lack of high-...
Given the results of PLATO anal cancer study, is 4140 cGy the new standard for early stage anal cancer?
The original Nigro regimen using 30 Gy was effective for anal cancer treatment, and so it is not surprising that 41.4 Gy for early stage anal cancer is similarly effective. The Lancet publication is a pre-planned secondary endpoint of cCR, and not the primary endpoint of the trial which is 3-year lo...
In the post-mastectomy setting, are there situations where only the regional nodes or targeted nodal basis are covered?
Thanks for asking this question. People occasionally ask this. Essentially all of the trials that show a survival advantage with PMRT used comprehensive local-regional therapy. So, doing something other than both the chest wall and nodes would not be based on the available data. Cancer is sneaky, i...
What is the optimal/safest regimen for re-irradiation of a partial chest wall following surgical resection of an isolated chest wall recurrence?
I agree with Ben that this is a difficult scenario. Resection with new tissue is ideal, but cannot always be done. Removal of the gross disease with some type of resection is also optimal if possible. Use of chemotherapy for isolated chest wall recurrence is controversial, but is often done. I pers...
What are your top takeaways in Breast Cancer from ASCO 2025?
My Top 3 takeaways in Breast Cancer from ASCO 2025 ASCENT-04: Sacituzumab Govitecan Plus Pembrolizumab as a New First-Line Standard for Metastatic PD-L1-Positive Triple Negative Breast Cancer (TNBC): The treatment landscape for metastatic TNBC continues to evolve rapidly. At ASCO 2025, presentation ...
In light of the NSABP B-51 data presented at SABCS, will you defer RNI in all patients with negative nodes after chemotherapy?
Results of the NSABP B-51 trial were presented at the 2023 San Antonio Breast Cancer Symposium (Mamounas et al., abstract GS-02-07). This trial was designed to test the value of postoperative radiation therapy in patients who presented with clinical T1-3N1 tumors with biopsy-proven axillary node inv...
What screening tools or signs do you use to predict if a cancer patient is near end-of-life?
For most of us, long-time practicing oncologists, all we have to do to determine that one of our patients is at the end of their life is to be in the same room with them. No special computer programs or calculators are needed. Just look closely at the patient's current weight, their level of conscio...
How do you assess and counsel women with chronic post-lumpectomy or mastectomy pain?
Post-surgical breast pain is not uncommon. Estimates suggest that 25-60% of patients having breast surgery experience persistent pain, with symptoms lasting from months to years following breast cancer diagnosis and treatment (Langford et al., PMID 25439318; Gartner et al., PMID 19903919).Initial as...