Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you consider definitive RT in a patient with oligometastatic bladder cancer who is not a surgical or chemotherapy candidate?
Oligometastatic bladder cancer has quite a poor prognosis and most local treatment in this setting is palliative in nature. Durable local control that provides hemostasis and prevents obstruction and other urinary issues is crucial. 30/10, 40/15, 55/20 are all potential options, but knowing that thi...
Is REZUM (water vapor thermotherapy for BPH) safe after EBRT?
Although I am not aware of any studies evaluating the toxicity rates in patients undergoing REZUM after RT, I am aware of a few studies reporting the toxicity of TURP after RT. For example, Liu and colleagues conducted a retrospective review of the outcomes of 1,192 patients, 246 of whom underwent a...
Do more fractionated regimens reduce severe toxicity over SBRT in patients with ILD and early-stage NSCLC?
I personally think fewer fractions are safer, such as 30 Gy x 1 instead of 10 Gy x 5, for patients with advanced COPD or ILD. Why? It's because each time a burst of ionization events is delivered to pulmonary tissues, a wound is created that recruits an inflammatory response, which can exacerbate th...
How do you approach the discussion about the potential risks of radiation therapy exposure and the development of secondary malignancies for patients with germline BRCA1/2 mutations?
It appears that the risk of secondary malignancies due to radiation exposure does not seem significantly enhanced in gBRCA-m carriers, unlike patients with Li-Fraumeni syndrome (for whom we would attempt to avoid radiation). The data on mBRCA-associated breast cancers would suggest that radiation is...
How are you interpreting the early RASolute 302 trial findings (daraxonrasib) in metastatic PDAC?
Update 6/2/2026: Well, this plenary abstract exceeded my expectations. That p-value! The possibilities for pancreas cancer treatment, it's a dream realized for our patients. Now, we need to keep our eye on the FDA to approve this quickly, and we also need to keep pushing for RAS inhibition in all p...
What features or presentations would prompt you to offer radiotherapy for paraganglioma vs. continued surveillance?
I think aside from symptomatic disease, other criteria I would consider for treating vs surveillance for paraganglioma include size/location where tumor growth in a particular location may lead to progressive/permanent neuropathies and therefore prophylactic RT may be warranted. I am also more likel...
Is there a role for adjuvant RT in a pleomorphic dermal sarcoma after WLE?
Adjuvant radiotherapy (RT) should be considered for pleomorphic dermal sarcoma on a case-by-case basis. There is no clear data to support the use or omission of radiotherapy in this disease, but we base our clinical decision-making on three factors: Estimated local recurrence risk Morbidity of treat...
How would you manage an enlarging brain metastasis that has progressed in size three months after radiosurgery?
Before making a decision, I would want to know the tumor histology, SRS dose delivered, and whether the current site of progression is truly within the prior radiation field (using new MRI fused to the SRS plan in treatment planning software). If the lesion is within the high-dose region and the pat...
Is radiation therapy contraindicated in the setting of an active abdominopelvic infection?
This question seems deceptively straightforward, but it is anything but straightforward. There are two major issues here: the first is what does "active infection" mean? The second is "why is radiotherapy being considered"? With respect to the infection issue, does the questioner mean an active infe...
What are your institution's standard liquid intake instructions for prostate cancer patients going through definitive external beam radiation?
Bladder filling is an endless source of stress for patients (and radiation therapists). It's hard for people to time bladder filling under ideal conditions, and even more challenging when the urethra and bladder are irritated from treatment. As the question alludes to, baseline hydration status infl...