Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When selecting mCRPC patients for Pluvicto, which baseline variables do you find most useful or predictive of potential hematologic toxicity?
One important consideration in the recommendation of Lu-177-PSMA radiopharmaceutical therapy (RPT) is an assessment of a patient’s marrow reserve, as hematologic toxicity is one of the most common clinically relevant toxicities after such treatment. Important clinical features to help assess the lik...
Would you consider neoadjuvant immunotherapy prior to radiation for a locally advanced skin squamous cell carcinoma?
While the definitive trials are yet outstanding and enrollment in NRG HN0014 (NCT06568172) should be encouraged where it is open, the present indications for using cemiplimab should follow its principal indication, unresectable cutaneous squamous cell cancer, a minority of cases at 5%. Practically s...
Would you offer hypofractionated PMRT to a pathologic T2N1a BRCA positive patient?
I would irradiate this patient due to the combination of a positive node and LVI, regardless of her age. I define "young" as age 40 years or younger; others use age 35 to 45 as cut-offs. It's not clear what this patient's age is based upon the information given.All of the data to date from randomize...
Are you offering hypofractionated comprehensive nodal irradiation following neoadjuvant chemotherapy for patients with locally advanced breast cancer in the setting of COVID-19?
In locally advanced breast cancer following neoadjuvant chemotherapy, we are offering hypofractionated radiation to the breast and regional nodes, and flat chest wall and regional nodes. In these cases, I treat to 40 Gy/15 fractions. For nodal coverage, I like to see 38 Gy line covering nodal basins...
What dose constraints do you use for hypofractionated radiotherapy for breast cancer undergoing regional nodal irradiation?
I offer hypofractionated treatment with RNI for patients following lumpectomy or mastectomy without reconstruction off trial. In those patients, in terms of constraints, I have typically used the Alliance trial hypofractionated arm constraints.
Is there any situation where hypofractionation of post-mastectomy radiation (CW and regional nodes) is absolutely contraindicated?
While not absolute given some phase 2 data, I am not currently offering hypofractionated PMRT to patients with reconstruction, as I am awaiting results of the Alliance trial. I do offer hypofractionated PMRT to patients who are not undergoing reconstruction. However, I am cautious in patients with c...
What are your top takeaways in Breast Cancer from ASCO 2025?
My Top 3 takeaways in Breast Cancer from ASCO 2025 ASCENT-04: Sacituzumab Govitecan Plus Pembrolizumab as a New First-Line Standard for Metastatic PD-L1-Positive Triple Negative Breast Cancer (TNBC): The treatment landscape for metastatic TNBC continues to evolve rapidly. At ASCO 2025, presentation ...
Do you offer low-dose radiation therapy for osteoarthritis of the spine?
DEGRO has published guidelines on this very topic, so I would respectfully disagree with a comment arguing a lack of data. Of course, if one is looking for level 1 data on irradiating benign diseases in general, there may be little to satisfy.That being said, there's no level 1 data espousing the be...
What are your top takeaways in GU Cancers from ESMO 2025?
KEYNOTE-905: These impressive results change the management paradigm of patients with MIBC who are surgical candidates but are not cisplatin-eligible. Over time, it may be that EVP perioperative therapy becomes the standard of care for all patients with MIBC with plans to proceed with cystectomy. I...
Would you omit radiation for an elderly woman with bilateral breast cancers (both early-stage disease and ER+/PR+/HER2 negative) who otherwise meets the criteria for endocrine therapy alone?
Yes. If the patient meets omission criteria on each side individually, then I offer omission to the patient overall as part of shared decision-making, although it is conceivable that the absolute benefit of radiation is doubled in this scenario. As usual, this assumes the patient will be compliant w...