Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you approach treating oligometastatic endometrial cancer in a patient with good performance status and no local recurrence at the primary site?
For metachronous OM would follow the SBRT approach/principle similar to other primary cancers after systemic treatment.
Would you consider definitive chemoradiation for small cell lung cancer that would otherwise be limited stage but has a solitary brain metastasis at presentation?
At the risk of sounding old-fashioned, a brain metastasis in a small cell lung cancer patient still makes them extensive, that is, stage IV. The standard of care for stage IV/extensive stage small cell lung cancer is systemic therapy and immunotherapy followed by immunotherapy consolidation, with ra...
When do you consider consolidation chest radiation in a patient with stage IV non-small cell carcinoma of the lung who has had good response to systemic therapy?
It's a really great question, and it comes up a lot in our tumor boards and general practice. There are a couple of paradigms that I use to help me think through when and how to do it. I would say the data here for the use of RT is mixed, and either gives you freedom to do a variety of things or giv...
Is there data to support treating postoperative endometrial pelvic EBRT with a daily dilator in the vaginal canal?
Data is more for GI malignancies on using a vaginal dilator to reduce dose to the anterior vaginal wall and thus the risk of stenosis. With the vagina being a target for endometrial cancer, there is no study using it during RT to show any benefit.Arzola et al., PMID 37898354
How would you treat a patient with basal cell carcinoma of the medial canthus, with ultimately negative margins after Moh’s surgery, if tumor was “peeled off bone?”
I would treat this patient based on a conversation with the dermatologist, not the PA or other assistant. I'd tell the office that I need the dermatologist to give me 15 minutes and to have all the slides ready for review of what was actually removed, as the periosteum is a good barrier. I reckon th...
In a patient with biochemical recurrence after radical prostatectomy for pT2 disease and a high-risk Decipher genomic classifier, with a PSA of 0.7 ng/mL, is there a rationale for administering salvage radiation therapy to the prostate fossa?
Yes, salvage RT to the prostate fossa (+ ADT/ pelvic lymph nodes) would be considered the preferred option in this circumstance, in my opinion (see NCCN 2026.3). Despite the PSA being higher than is typical in 2026 and some risk factors for not responding to RT (e.g., margin-negative resection), it ...
Would you continue serial PSMA PET scans after 2 negative scans for patients with a persistently rising PSA post-RT?
Some context would probably be helpful for this. E.g., PSA >2 is different for a patient post-prostatectomy vs. post-radiotherapy. But, in general, if clinical suspicion of cancer recurrence/progression is high, and PSMA PET is negative, one can consider the following options: There may not be a ca...
How do you manage cancer treatment-related cognitive change or "chemo brain?"
Chemo-brain is a vexing and complicated diagnosis. In most cases, you don't know the baseline neurocognitive function of individuals with cancer. Many conditions that are associated with chemotherapy like fatigue, depression, and aging can mimic chemo-brain. Estimates are that about 20% of individua...
How, if at all, have you incorporated GLP-1 agonists into your fertility-sparing management of patients with EIN or endometrial cancer?
That is a question that needs to be more clearly defined. We have a project in our endometrial SPORE grant that seeks to answer that question. This project is led by Andrea Hagemann at Washington University. In this project, the effect of weight loss, augmented by GLP1 agonists with weight loss coun...
How long would you hold cemiplimab before and after thoracic chemoradiation?
Cemiplimab is certainly not the accepted standard ICI to be used after chemoradiation in stage III NSCLC, although it is being tested in the SPORADIC trial as part of induction chemo-ICI and consolidation ICI with radiotherapy alone in patients unfit for chemoradiation. It is not advised to give con...