Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Are there situations in which you would definitely recommend radiation in an elderly patient with ER+, early stage breast cancer?
I always have a little trepidation in answering questions whereby I would “definitely†recommend any therapeutic path as clinical decision making needs to be a bit more nuanced. Every situation requires a careful weighing of multiple inputs including clinical trial data and patient-specific fact...
What are your top takeaways in Neuro Oncology from ASCO 2025?
Aizer et al., JCO 2025 - A multi-instituitional Brigham Dana-Farber-led trial randomized 196 patients with 5-20 brain metastases to stereotactic radiosurgery (SRS) or hippocampal avoidance whole brain radiotherapy (HA-WBRT). Patients treated on the SRS arm had significantly less symptom burden, wit...
Do you recommend IM biopsy in the initial staging of breast cancer patients with suspicious IM nodes on imaging?
I think it is always preferable to biopsy suspected cancer sites when developing a therapeutic plan. Biopsy provides a greater degree of certainty in clinical decision making and can be informative when evaluating outcomes of care retrospectively for quality improvement or research projects. However...
If an asymptomatic patient requires a delay up to a week before starting chemotherapy for Stage III lung cancer, do you also push back the radiation start date?
Typically, the reason for B12 and folate prior to chemotherapy is related to the drug that will be used, pemetrexed. Giving the premedication reduces hematologic and gastrointestinal toxicity to tolerable levels. One week typically will not make a difference and I would usually wait to start. Howeve...
How have you incorporated gene expression profiling tests for melanoma or SCC into your practice and has it changed your approach to treatment and/or monitoring?
This is a controversial topic for sure, but most emerging technologies in medicine are. I do use gene-expression profiling in the treatment of cutaneous SCC and invasive melanoma. My theoretical framework for using GEP testing is that it is a forward looking test, while clinical staging is backward...
How do you counsel families of pediatric patients regarding risk of secondary malignancy or IQ changes with cranial radiation using photons?
It’s a great question as these are two of the scariest things that families face when you relay the potential risks of cranial radiotherapy. Simple things like timing of these topics in the consent discussion can make a difference. Don’t start with the scariest potential risk when doing the consent,...
What is your approach to post-operative radiation (when to offer, volume, dose, fractionation) for a primary intraosseous squamous cell carcinoma (PIOCC) of the head & neck?
I probably would. 60 Gy in 30 fractions for negative margins and electively treat the neck.
What dose of radiation do you use for neoadjuvant chemoradiation in esophageal cancer?
The CROSS trial does not exist in a vacuum. We have a long history of esophageal trials by the RTOG and other cooperative groups that consistently used chemoradiation to 5040 cGy, and this remains the standard of care in the U.S. That said, if I have to treat a very long tumor, resulting in lung met...
Should axillary imaging be routinely performed in all patients with a new diagnosis of breast cancer?
This issue has been debated but I would argue that patients with a new diagnosis of breast cancer should not undergo routine screening US of the axilla to look for clinically occult disease. The axillary US should be limited to diagnostic imaging for clinically suspicious nodes on clinical exam or b...
How would you approach a triple negative carcinoma of the axilla with unknown primary and a CR after neoadj chemo followed by ALND?
Breast plus RNI excluding dissected axilla.