Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Given the final publication of NSABP B-51, for which patients meeting trial eligibility would you still recommend regional nodal irradiation?
The very first thing that should occur before one makes a decision about what they are going to do is to understand how the trial was designed and who was actually accrued to it. The first point is that B51 was a superiority and not a non-inferiority trial. A very related point to that is that they ...
What RT dose/fractionation would you use to treat an unresectable grade 3 solitary fibrous tumor abutting the optic nerve and chiasm?
Generally, I would consider treating an unresectable grade 3 solitary fibrous tumor to up to 59.4/60 Gy, or possibly higher. The location of this tumor makes it difficult to treat entirely using this dose while respecting the optic nerve/chiasm constraints. How is the patient's vision? If intact, op...
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...
How are you using ArteraAI in 2026 for intermediate risk patients?
I use both ArteraAI and Decipher to help with these decisions. As Dr. @Dr. First Last says, it's post-hoc based on large datasets. Artera claims to be predictive, while Decipher is just prognostic. Without going through all the data, I find it helpful for intermediate risk, where it is on the cusp o...
In a patient with isolated inguinal nodal recurrence one year after a margin negative anal excision for Grade 1, T1 SCCA of the anus, would you include the anal canal/rectum as part of salvage chemoradiation therapy?
Absolutely yes- the risk is lower for T1 8-10 percent but it is possible. Given the failure should include the entire anal canal and RNI to at least 45 /25 and can SIB gross node to 50 plus depending on size. Anecdotally I had one case like this , resected small T1, node failure where only the ingui...
How do you advise a patient with a history of HR+ breast cancer who would like to go on HRT for postmenopausal symptoms?
I would say systemic hormone replacement therapy is generally not recommended because of concerns about recurrence. I would assess the severity of symptoms and explore non-hormonal options. If her main concern is vaginal symptoms, low-dose vaginal estrogen may be an option depending on the severity ...
Is salvage SBRT an option for focal recurrence of PCa after prior proton therapy for intermediate-risk disease?
Yes, it is an option. There is a great need for randomized trials in the setting of local-only recurrence after definitive RT, and we do not know the optimal approach. The MASTER systematic review and meta-analysis is a good summary (Valle et al., PMID 33309278). I do not think that protons vs. phot...
Would you offer ultra-hypofractionated breast radiation for a patient with a 4.5 cm IDC but otherwise favorable characteristics?
Tumor size is not a limiting factor for selecting the 5-fraction regimen (FAST-Forward). Dose distribution is more important. A boost would be added, especially for patients younger than 50.
What planning and dose constraints are you using for 5-fraction hypofractionated FRST for vestibular schwannoma?
When using fractionated SRS (fSRT) of 25 Gy in 5 fractions for vestibular schwannomas, I use only 2 constraints: the brain stem and the cochlea, if the patient has serviceable hearing. In this case, the only OAR needed is the brain stem, 23 Gy <0.5 cc. I don't worry about the trigeminal nerve as it ...
What is the appropriate amount of time to allow for wound healing prior to post-operative radiation for metastatic disease?
I typically have waited about 4 weeks or so to start RT after ORIF. In addition to limiting risk of wound complications, this allows time for the patient to adequately recover from a pain perspective, since if one tries to treat earlier, the tolerance of treatment is often poorer. In situations wher...