Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you recommend placement of a rectal spacer when delivering radiotherapy to the prostate in patients with oligometastatic prostate cancer?
No. I have had a few patients seek it out on their own, which is fine. But I tell them it is not necessary.
What are your top takeaways in Radiation Oncology from SABCS 2025?
Several significant studies were presented at San Antonio this year. I will focus on the three most important abstracts reporting new data from studies of local-regional therapy. (The 10-year update of the BIG 3-07-TROG 07.01 trial comparing hypofractionated and conventional fractionation and the us...
What dose constraints do you use when treating a patient with bilateral breast cancer with RNI?
This article highlights lung, heart, esophagus, and dose homogeneity constraints we aim for when treating bilateral breast cancer and RNI. Li et al., PMID 41272934
How do you interpret nodes with minimal increased uptake on PSMA PET in prostate cancer?
This question is relatively similar to another recent question on indeterminate PSMA PET (#26360), where I provided a longer answer in a bit more detail. The summary is that this essentially relies upon your clinical judgement, and there is no definitive algorithmic way to determine the true nature ...
How do you treat a large basal cell carcinoma involving the dorsum and entire tip of the nose when brachytherapy and orthovoltage are not feasible?
IMRT with dot decimal or flexible custom bolus. Requires a few scans and send-out for bolus fabrication, but I have seen some nice results.
When offering palliative radiation for breast cancer, what dose/fractionation do you prefer and in what subset of patients do you believe derive the most benefit?
More recently after FAST-Forward, use 26 Gy in 5 for palliation as shorter and reasonable dose to palliate pain, bleeding, and drainage.
How would you treat bilateral groin recurrence of vulvar small cell neuroendocrine carcinoma in a patient who has previously had pelvic and groin radiation?
I would start with chemo-immunotherapy, like in pulmonary small cell, as this is likely to be the tip of the iceberg. If no prior groin surgical exploration, this can be considered by gyn/onc. If not, I would consider focal reirradiation of any residual disease after chemotherapy during IO maintenan...
Do you recommend progesterone for endometrial protection in a young woman on estrogen replacement therapy for iatrogenic menopause after definitive radiation therapy for locally advanced cervical cancer?
For women with a uterus, I give a combination of estrogen and progesterone therapy, even after definitive radiation therapy. Transdermal preparations have the advantage of bypassing first-pass effect of the liver, but oral combinations are also acceptable.
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...
Does an esophageal stent impact your radiation treatment plan for a patient with non-metastatic GE junction adenocarcinoma?
While the presence of a stent might not directly affect my radiation dose and volumes, due to numerous other considerations, it would certainly affect my overall treatment plan. I highly encourage avoiding a stent in the setting of radiation due to toxicity concerns in addition to the complications ...