Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you omit pelvic XRT in a high risk prostate patient with negative nodal uptake on PSMA but has risk of nodal involvement >15% by nomogram?
Based on POP-RT, if they are a high-risk group, I would add pelvic RT.
How do you counsel patients/families whose goals of care are clearly aligned with a comfort-focused, end-of-life approach, but who are hesitant to formally enroll in hospice?
Hospice sounds like a 4-letter word to a lot of families! I find it important to distinguish the philosophy of comfort care vs. the benefit package associated with enrolling in hospice. Some people are able to be provided end-of-life comfort care without electing the hospice benefit, and that is fin...
Do you ever perform adaptive replanning for interfraction tumor volume changes appreciated during a fractionated SRS (5 fx) treatment for CNS metastases?
I have done adaptive re-planning in the past for tumors that had obviously grown based on CBCT (i.e., intraventricular metastases) from the time of sim to treatment for LINAC-based SRS. I think certainly in the other situation (i.e., obvious decline in size of tumor where one is quite confident base...
Do you use any strategies to minimize loss of taste from radiation for oropharyngeal cancer?
In a prospective longitudinal study of QoL in OPC patients receiving chemo-IMRT, where patient-reported dysgeusia was one of the items, we reported a significant association between severe dysgeusia and mean radiation dose to the oral cavity (P=.005) (Sapir et al., PMID 27473816). NTCP for severe dy...
Do you use an SIB schema for salvage post-prostatectomy RT when treating the fossa in ~33-39 fractions and including the pelvic lymph nodes?
Some have adopted 25 fraction regimens with the simultaneous delivery of 62.5 Gy to the operative bed and 45-50 Gy to the regional pelvic lymphatics, in part based on the randomized NRG-GU003 (Buyyounouski et al., PMID 38483412), which should be reporting updated results on efficacy and toxicity lat...
Do you routinely cover the laminectomy site when treating with spine SBRT?
I have never covered the laminectomy incision site with spine SBRT and would worry about the risk of wound complications in doing so. I have not personally seen laminectomy site recurrences [I do follow patients closely with clinical and radiographic (MRI) surveillance following post operative spine...
If adjuvant radiation is offered to an elderly patient with H&N SCC s/p Mohs surgery who is planned for multi-stage reconstruction of the defect with plastic surgery, when should adjuvant radiation be started?
Tumor control comes first. If the surgical defect is such that reconstruction is required, it is even more imperative to focus on the above principle, as a recurrence would almost certainly risk ruining the entire collective effort. Vascular flaps could be safely performed post-RT in most cases by s...
For ALK+ patients rendered NED from oligometastatic NSCLC after resection of both lung primary and isolated CNS lesion, do you consider offering treatment with an ALK inhibitor after adjuvant chemotherapy, or do you place into surveillance?
A large proportion of patients with oligometastatic disease managed with curative intent generally relapse, either intracranially and/or extracranially. In an analysis of NCDB outcomes, our group showed that NSCLC patients with synchronous brain metastases who underwent thoracic surgery and received...
Do you see MR Linac having a role in the treatment of CNS disease?
MR Linac has a lot of potential in the management of CNS neoplasms. To best understand its potential, it is critical to understand what the genuine value proposition of the MR Linac really is. At its heart, and rather simplistically, many view it as simply another option for image guidance to suppor...
What are your top takeaways in Thoracic Cancers from ASCO 2026?
At the ASCO 2026 meeting, two important trials on NSCLC were presented in the Plenary Session that may have a significant impact on future management in these patient populations. Phase III LIBRETTO trial- 432: Presented in this year's ASCO Plenary Session. This trial included NSCLC with a RET fusio...