Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In the post-mastectomy setting, are there situations where only the regional nodes or targeted nodal basis are covered?
Thanks for asking this question. People occasionally ask this. Essentially all of the trials that show a survival advantage with PMRT used comprehensive local-regional therapy. So, doing something other than both the chest wall and nodes would not be based on the available data. Cancer is sneaky, i...
What is the optimal/safest regimen for re-irradiation of a partial chest wall following surgical resection of an isolated chest wall recurrence?
I agree with Ben that this is a difficult scenario. Resection with new tissue is ideal, but cannot always be done. Removal of the gross disease with some type of resection is also optimal if possible. Use of chemotherapy for isolated chest wall recurrence is controversial, but is often done. I pers...
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 ...
In light of the NSABP B-51 data presented at SABCS, will you defer RNI in all patients with negative nodes after chemotherapy?
Results of the NSABP B-51 trial were presented at the 2023 San Antonio Breast Cancer Symposium (Mamounas et al., abstract GS-02-07). This trial was designed to test the value of postoperative radiation therapy in patients who presented with clinical T1-3N1 tumors with biopsy-proven axillary node inv...
How do you assess and counsel women with chronic post-lumpectomy or mastectomy pain?
Post-surgical breast pain is not uncommon. Estimates suggest that 25-60% of patients having breast surgery experience persistent pain, with symptoms lasting from months to years following breast cancer diagnosis and treatment (Langford et al., PMID 25439318; Gartner et al., PMID 19903919).Initial as...
Do you recommend placement of a rectal spacer when delivering radiotherapy to the prostate in patients with oligometastatic prostate cancer?
No. I have had a few patients seek it out on their own, which is fine. But I tell them it is not necessary.
What dose constraints do you use when treating a patient with bilateral breast cancer with RNI?
This article highlights lung, heart, esophagus, and dose homogeneity constraints we aim for when treating bilateral breast cancer and RNI. Li et al., PMID 41272934
How do you treat a large basal cell carcinoma involving the dorsum and entire tip of the nose when brachytherapy and orthovoltage are not feasible?
Hard to know without seeing, but likely create 3D bolus and treat with electrons. Can also potentially do IMRT/VMAT with photons, likely more homogeneous dose distribution, but I typically favor electrons just based on comfort.
When offering palliative radiation for breast cancer, what dose/fractionation do you prefer and in what subset of patients do you believe derive the most benefit?
More recently after FAST-Forward, use 26 Gy in 5 for palliation as shorter and reasonable dose to palliate pain, bleeding, and drainage.
Do you recommend progesterone for endometrial protection in a young woman on estrogen replacement therapy for iatrogenic menopause after definitive radiation therapy for locally advanced cervical cancer?
For women with a uterus, I give a combination of estrogen and progesterone therapy, even after definitive radiation therapy. Transdermal preparations have the advantage of bypassing first-pass effect of the liver, but oral combinations are also acceptable.