Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you follow/manage patients with metastatic prostate cancer with undetectable PSA and castration-sensitive but active disease on PSMA PET?
Summary: This is a challenging clinical scenario, and one in which I think there is currently a lot of practice variability. In such cases, I would not jump to action immediately, and I would first try to obtain some additional information. This would include repeat PSA for confirmation as well as f...
How would you manage RT for a locally advanced squamous cell carcinoma of the anal canal in a >90-year old if chemotherapy is not recommended?
For any elderly patient, a discussion of goals of care in the context of symptoms is warranted. In the chance this is a small asymptomatic cancer in a patient with limited life expectancy, no therapy may be reasonable. However, this does not seem to be the case for your patient.If the patient is dee...
Do you recommend prostate RT for patients with metastatic (M1) disease?
My short answer to this provocative question is “no, I don’t offer men with M1 disease local radiation unless there’s a palliative need.” Treating the primary in the asymptomatic M1 scenario, whether with RT or with surgery, is a major commitment of time, resources, and risk to the patient. The leve...
What would be your radiotherapy plan for an overall stage IIA, low-lying, MMRd rectal adenocarcinoma to try to avoid APR?
For an MMRd rectal cancer, I would use immunotherapy! Very promising data from MSKCC suggesting upwards of 100% clinical complete response with dostarlimab alone, without the need for RT!
Would you consider a patient with DLBCL to have CNS involvement if no brain lesion is seen on imaging, CSF flow cytometry is negative, but PCR is positive for MYD88 and KMT2D mutations?
Cerebrospinal fluid (CSF) is an ultrafiltrate of plasma contained within the ventricles of the brain and the subarachnoid spaces of the cranium and spine. It is possible that cfDNA fragments containing MYD88 and KMT2D mutations may have found their way into the CSF and thereby detected by PCR techni...
Would you recommend radiotherapy for upper-tract urothelial carcinoma in an inoperable patient?
I am hardly an expert on the topic, but have performed SBRT in this scenario. I found this paper very helpful for treatment planning. Evans et al., PMID 29556581.
Is there evidence for any difference in outcomes or complications for patients with Crohn/IBD who receive low-dose radiotherapy for hip osteoarthritis?
I'd be surprised if there is any data on this topic; if there is, I am unaware of it. I think the risk of RT-related complications in this situation is quite low. However, if presented with this situation, I would: a) obtain informed consent recognizing the possibility of an adverse result, and b) c...
For a patient with IIIC1 (micromets), MSI-high, Grade 2 endometrial adenocarcinoma who has undergone full surgical staging, do you recommend adding immunotherapy to adjuvant chemotherapy + radiation?
Short answer: No, I do not recommend adjuvant CT/IO + RT for this patient based on the patient's risk factors in the prompt, and the data below. Should the patient have recurrent/metastatic disease following adjuvant CT + RT/VCBT, then I/O + CT is a good option. Ongoing trials hope to answer this qu...
Would you consider applying the principles of STAMPEDE with <5 oligometastatic non-regional lymph nodes from prostate cancer?
About 25% in STAMPEDE had low volume metastatic disease with no bone Mets, with most having a non-regional node in that category to qualify as low volume Mets.That being said, common iliac could be the primary drainage of prostate cancer based on SNLN studies and I would favor treating like node-pos...
What are your top takeaways in GU Cancers from ASCO 2026?
1. A-DREAM (Alliance A032101): Can We Give Patients a Break from ADT?For men with APMS prostate cancer who achieve exceptional biochemical responses to testosterone suppression (TS) plus an ARPI, can treatment be safely interrupted to allow testosterone recovery and improved quality of life?Single-a...