Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How long of a delay are you willing to accept for vaginal cuff brachytherapy either as primary therapy or as boost?
The absolute benefit of vaginal cuff HDR boost is small and 6 months delay would negate any such benefit.
How do we reconcile what appears to be a more aggressive surgical resection for DCIS than for invasive disease?
The guidelines panels did an outstanding job in generating both the DCIS and the invasive cancer margins guidelines. It needs to be recognized, however, that despite the sophisticated meta-analysis upon which the recommendations are based, the studies in the meta-analysis had limitations. Appropriat...
Do you offer adjuvant radiation therapy for a breast cancer patient with dermatomyositis?
This is an exceptionally important question for clinicians. I'm a little biased as I run an autoimmune Myositis Clinic, but here are my two cents: Paraneoplastic dermatomyositis (DM) is a fairly common occurrence (roughly about 15% of all DM cases, but up to 30-40% in some subtypes, such as adult pa...
What is the role of adjuvant radiation in R0 node positive resected pancreatic adenocarcinoma in light of the recently presented RTOG 0848 abstract?
There are three options here in my practice. 1) Treat, 2) don't treat, and 3) "watch and wait, then ablate" (for a local recurrence). In general, I treat patients with CXRT who have positive margins (IMRT 45 Gy/25# to regional volume with SIB of 62.5 Gy to the margin. If it is an R2 resection (which...
Do you offer adjuvant radiotherapy for pancreatic adenocarcinoma following surgical resection?
Unfortunately, the data on adjuvant radiation therapy is not answered. Most of the randomized studies (such as the flawed ESPAC study) do not show a definite advantage to RT (or even a disadvantage), and the non-controlled studies tend to be positive. There are a few things that we can say with some...
When treating pancreatic cancer with adjuvant chemoradiation, do you treat the initial field to 50 Gy, as per RTOG 0848, or to 45 Gy?
What I do: R0: 50.4 Gy in 28 fractions 3D CRT with a field reduction at 45Gy off of the jejunal reconstruction as much as possible The 45Gy goes to the SMA, Celiac, porta and tumor bed. R1: (path says margin <1mm or postive, no soft tissue near SMA in CT): Boost to 54Gy with 3DCRT. R2: Gross disease...
Within what timeframe should adjuvant radiotherapy start for Merkel cell carcinoma of the head and neck region?
I use a 4-6 week post-op timeframe for adjuvant RT for Merkel cell carcinoma. I always prefer closer to 4 weeks, whenever possible.
Is 80 Gy/40 Fx + ADT the new standard of care for definitive radiation of high risk prostate cancer?
For those who want a more thorough answer, enjoy. If you want you can skip to the end for the summary: For well over a decade, we are taught that dose escalation improves biochemical control but not overall survival, while ADT improves both. Do the results of GETUG AFU-18 change this? Let's take a l...
How do you approach cisplatin dosing for locally advanced head and neck SCC in HPV-positive and HPV-negative patients?
Weekly cisplatin 40 mg/m² is not yet considered equivalent to high-dose cisplatin 100 mg/m² every three weeks, and high-dose cisplatin remains the preferred regimen for both HPV-positive and HPV-negative locally advanced head and neck squamous cell carcinoma. However, weekly cisplatin is an acceptab...
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...