Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What are your top takeaways in Head & Neck Cancers from ASCO 2025?
The phase 3 KEYNOTE-689 and the phase 3 NIVOPOSTOP. A key distinction is that KEYNOTE-689 incorporated both neoadjuvant and adjuvant immunotherapy, while NIVOPOSTOP restricted immunotherapy to the adjuvant phase and specifically targeted patients with high-risk features (+ margins and ECS) post-surg...
How do you manage bladder spasms during pelvic radiotherapy?
My approach would depend on the disease under treatment, specific symptoms, concurrent therapies, and whether or not the patient has a prostate. The first thing I would do, if you have not already done it, is obtain a urine sample to rule out infection. Let's assume that was done and there is no inf...
Would you offer re-irradiation for a prostate local recurrence after I-125 seed implant >10 years ago in a healthy young patient with life expectancy >15 years?
While I think salvage re-irradiation does have the potential to become a routine option in such situations, I think further study is required to define both the efficacy and toxicity profile prior to establishing it as such. The current state of knowledge is based on limited information, as Dr. @Dr....
Given the results of PORTEC-4A, what adjuvant therapy, if any, would you offer a patient with a POLE-mutant endometrial cancer who also has a p53 mutation and substantial (>5 foci) of LVSI?
When you have dual mutation, the better of the two mutations drives the outcome, so it would be treated like a POLE-type. If substantial LVSI and pathological nodal assessment are done, I would favor Brachy alone. If nodes are not assessed, I would favor EBRT. The link below has references about dua...
How should you manage a pediatric oncology patient who has an ANC > 500 and a normal chest x-ray but is confirmed to be infected with COVID-19 and is immunosuppressed from chemotherapy?
The treatment for pediatric patients with cancer who develop COVID-19 is very poorly defined. The risk of severe disease is unknown because although adults with cancer appear to have worse outcomes than those without, non-immunocompromised children seem to have few severe outcomes from the disease a...
Do you attempt to spare the submandibular glands in head and neck IMRT?
I do too. The primaries I consider electively treating 1B nodal station are: oral cavity, nose and anterior nasal cavity, lip, medial cheek/mid face, and node positive parotid. The submandibular gland itself is devoid of lymph nodes and is rarely ever involved by Sq cell Ca (versus the parotid gland...
Is there any evidence for combining surgery and XRT +/- ADT for treatment of localized high risk prostate cancer?
Presumably, this is a question inquiring about planned post-operative RT. If so, surgery followed by adjuvant, post-operative radiation therapy (PORT) has been profiled extensively in several RCTs: EORTC 22911, SWOG 8794, ARO 96-02, FinnProstataX. The two more recent trials, ARO 96-02 and FinnProsta...
For locally advanced rectal cancer, will the recent update of RAPIDO lead you to change your practice when approaching TNT?
We prefer long course chemoradiation followed by consolidation with FOLFOX and non-operative management based on the OPRA trial, which reported 60% versus 40% using this sequence versus initial chemotherapy.
How do you manage an implanted insulin pump or continuous glucose monitoring device during radiation?
We do not have an official written policy yet, but honestly, we probably should develop one, since these devices are becoming more prevalent. For CGMs, we ask the patient to place the device far from the treatment site while under treatment and to verify function with finger stick glucose measuremen...
How would you approach SBRT in a pacemaker-dependent elderly patient with Stage I NSCLC whose SBRT plan Dmax exceeds the pacemaker tolerance?
For any patient who has a pacemaker, we always send them to be evaluated for the device by a cardiologist before simulation and after finishing all fractions of the SBRT. In addition, we check their vital signs daily after each fraction of SBRT. For SBRT planning, we will minimize irradiating the p...