Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the role of adjuvant RT for metastatic RCC to the thyroid resected with high-risk features?
There is no established role for adjuvant radiotherapy after thyroidectomy for RCC metastases, even with high-risk features. Most published evidence consists of small retrospective series or case reports. When RT is used, it’s generally for palliation. That said, selected high-risk cases (positive m...
What are your top takeaways from ASCO GI 2025?
1. BREAKWATER: Analysis of first-line encorafenib + cetuximab + chemotherapy in BRAF V600E-mutant metastatic colorectal cancer. This ambitious phase 3 randomized trial is an initiative of project frontrunner to attempt to allow access of targeted therapy in earlier lines of treatment for advanced ca...
In a patient with metastatic colorectal cancer to the lung and liver, is there a role for liver directed therapy if the lung is not amenable to local therapy?
This is a heterogeneous group of patients, so I don’t think there is one answer applicable to all clinical situations. This is why it is so important that these patients be discussed in a multidisciplinary setting. I’m assuming that in this situation the patient has had adequate systemic therapy to ...
Would you offer postoperative RT for pT2pN0 rectal cancer with close distal margin (within 2 mm) and only 6 lymph nodes obtained from surgery?
I assume the question is about the addition of chemoradiation in this setting. In this case, there is one clear reason to consider post op chemoradiation - the 6 LNs removed. This is clearly short of the standard for adequate lymphadenectomy of 12. It may be possible to ask the pathologist to review...
How do you incorporate radiation therapy in patients undergoing CAR T-cell therapy for DLBCL?
It depends on the circumstances of the patient, but there are three emerging indications for RT in the setting of CAR T-cell therapy: Tumor debulking prior to CAR T-cell infusion Bridging therapy between apheresis and CAR T-cell infusion Salvage of refractory, progressive or relapsed disease follow...
When using SBRT to treat unresectable pancreatic cancer after induction chemotherapy, do you treat elective lymph nodes?
Short answer - yes, we started doing this ~6 months ago.Longer answer: Our practice has changed here recently. Initially, when offering ablative radiation for locally advanced unresectable pancreatic cancer, either with 15-25 fractions on a conventional linac or with 5 fractions on an adaptive platf...
How would you define your radiation treatment volume for a primary diffuse large B-cell lymphoma of the L4 vertebral body that had a complete response to chemotherapy?
For a primary DLBCL involving only the L4 vertebral body with a CR after chemotherapy, we would include just the involved L4 vertebral body. There is no need to include one vertebral body above and below. Effort should be made to reduce excess dose to the bowel and adjacent bone marrow with either a...
Would you treat rectal squamous cell carcinoma the same as rectal adenocarcinoma, stage for stage?
No, I will treat rectal squamous cell carcinoma the same as anal squamous cell carcinoma, with definitive chemoradiation with 5FU/mitomycin. If the cancer invades the posterior vaginal wall or prostate, I will also include external ilac nodes. If the tumor involves lower rectum/anus, I will also tre...
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...
For a patient with locally current endometrial cancer whose disease had complete radiographic response to carboplatin, Taxol, and pembrolizumab, would you consider adding radiation therapy?
Despite having a complete response to chemoimmunotherapy, I would tend toward adjuvant RT since this was a local recurrence. We don't have long-term data with chemoimmunotherapy in this locally recurrent setting.