Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the optimal management of pain and loss of function due to pathologic compression fractures?
I explain to my patients if they have an acute compression fracture that they are likely to experience pain for approximately 2-3 weeks that will gradually resolve. I often give them some type of pain relief using Tylenol or ibuprofen and if severe, a more potent analgesic for a short period of time...
Is it appropriate/safe to utilize bolus with ultra-hypofractionated breast radiation?
There are no data I know of on using bolus with the FAST-Forward regimen. I would be very reluctant to do so because of the lack of time for healing of the skin between fractions and concern about long-term hyperpigmentation and telangiectasias if the patient had breast-conserving therapy. However, ...
How do you monitor for cardiac toxicity in patients taking osimertinib?
There are multiple studies that have explored the issue of cardiotoxicity from osimertinib. A large single-center retrospective observational cohort series from Taiwan, (n=401) compared a matched cohort of patients treated with osimertinib (n=253) to those treated with other EGFR TKIs (n=195) and fo...
What would your approach be in a man currently on treatment for high-risk prostate cancer with ADT who does not have castrate levels of testosterone?
Yes, I would try alternative agents. If using Lupron, consider relugolix, degarelix, high-dose bicalutamide, or even adding an ARSI.
In a patient with metastatic prostate cancer on abiraterone planning to start Radium-223, what is the minimum interval between the last dose of abiraterone and the first dose of Radium?
Update, May 16, 2026. The context of the question changes based on recently published data. These include the safety of combining an androgen receptor pathway inhibitor (ARPI) with Ra-223 and the utility of this approach in the evolving practice of metastatic prostate cancer.Abiraterone has a half-l...
Do you omit PMRT for patients who would have been eligible for NSABP B-51, but are found to have significant pure LVSI only, without stromal carcinoma, after neoadjuvant chemotherapy?
I would treat it like a partial response and favor RT.
What if any, is your radiation approach to treating hepatic metastases abutting/invading luminal GI structures?
My approach to hepatic metastases abutting luminal GI structures is fundamentally conservative. When liver metastases abut or threaten invasion of the stomach, duodenum, or bowel, I do not treat this as a classic SBRT scenario. The priority shifts from local ablation to durable local control and pre...
How do you approach the management of basal cell carcinoma with single lymph node involvement?
If all the tumor has been resected, I would recommend adjuvant XRT on the nodal basin, depending on the age of the patient. For very old patients or patients with comorbidities, observation might be warranted. If there is remaining BCC visible on examination or scans, I would treat systemically with...
When treating chestwall + RNI with VMAT, how much do you crop the PTV into lung as is done with the PTVeval in 3D contouring guides?
We don’t edit PTV for VMAT plans. Chest wall contour (CTV) only includes pec muscles (not intercostal muscles or ribs like RTOG ATLAS) so the amount of PTV (3-5 mm expansion of CTV) overlap with lung is minimal to begin with. We do use a dummy bolus to create skin flash.
What dose-fractionation scheme and esophageal constraints should be used to treat an ultra-central, medically inoperable, stage I NSCLC abutting the esophagus?
For lesions abutting the esophagus, SBRT with BED >100 Gy should NOT be used due to high risk for ulceration and even fistula. Instead of SBRT, more fractionated radiotherapy with BED <84 Gy should be considered (60 Gy in 15 FX is still too high for the esophagus). In addition to maximal point dose,...