Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Which patients with locally advanced cervical cancer would you consider as candidates for moderately hypofractionated pelvic chemoradiation before brachytherapy?
At present, would not offer outside clinical trials, as data are limited, with some suggesting a higher risk of acute morbidity also. Doses of EBRT in these studies are also not similar, varying from 37.5 in 15, 40 in 16, 44 in 20, and 43.3 in 17.
Does pleural tenting adjacent to tumor impact your target volume for early stage NSCLC planned for SBRT?
Having reviewed the images in the cited paper, the question of how to define the target for tumors with proximity to the chest wall and that also show pleural tenting is one that my thoracic radiation oncology colleague will often discuss. The brief answer is that although tenting likely represents ...
If adjuvant radiation is indicated for a Merkel cell carcinoma of the upper extremity and hypofractionation is desired, what dosing regimens are recommended?
While more common cancers (breast, prostate, etc.) have well-designed clinical trials that demonstrate equivalence of hypofractionated radiotherapy and conventionally fractionated radiotherapy, similar types of studies are lacking in less common cancers like Merkel cell carcinoma. Part of the diffic...
How do you approach adjuvant radiation recommendations for low-risk endometrial cancer in which the patient was unable to undergo pelvic sentinel node mapping?
Nodal assessment would not change much for me, as it’s a low-risk disease, and PORTEC data have shown the risk of nodal recurrence is low. For focal LVSI, one may consider brachy alone.
What criteria are you using for retreatment with Pluvicto (Lu-177) in those who maintain a good performance status and appropriate lab work?
Mainly, whether or not they've exhausted standard options. At the time I'm answering this, Pluvicto is approved for castration-resistant metastatic disease, either pre- or post-taxane chemotherapy. If they have not had chemo, I usually recommend it. If they have, I get their medical oncologist to we...
Would you irradiate elective lymph nodes for a T1 Merkel cell carcinoma of the head and neck with a negative sentinel lymph node?
In general, I would not irradiate due to the negative sentinel lymph node biopsy (SLNBx). Either one trusts the prognostication of a SNLBx and obtains one, or not. If one does not trust the process of SLNBx, then you should not obtain one and electively treat. I do not see the utility in obtaining a...
Would you recommend sentinel lymph node biopsy at the time of wide excision for a 3 mm Merkel cell carcinoma of the cheek/lateral canthus?
Unlike melanoma and certainly NMSC, MCC is highly unpredictable in nature, with clinical lesion size having little clinical prognostic value. As such, it appears that SLNB is valuable in many cases for the purposes of prognosis and in determining the need for adjuvant systemic therapy and radiation....
Would you consider ultra-hypofractionated 5 fraction regional nodal radiation in a node + breast cancer who otherwise wouldn't tolerate 16 fractions of RT?
At this time, unless there was a strong reason that hypofractionated breast + RNI in 15-16 fractions couldn't be done, I wouldn't use 5 fx breast + RNI off-trial. If compelling reasons, one could consider extrapolating safety of breast RT from FAST/FAST-Forward and axilla from melanoma data.
Do you offer consolidative radiation for oligometastatic breast cancer?
I'd like to add a few additional considerations to the already excellent responses from our colleagues. Many of the trials cited actually address two related but distinct clinical questions, and the answer for HER2-positive disease specifically may diverge from the population-level results.Trials of...
How would you treat an elderly patient with metastatic breast cancer with two new progressive right breast/chest wall lesions?
I addressed the question of how to manage patients with symptomatic breast masses in a posting on December 19, 2025. The first question for this patient with progressive lesions is whether they are symptomatic now or not. If not currently symptomatic, then I would likely defer RT until such time as ...