Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Can the elective target volume in nasopharyngeal cancer, as specified in RTOG 0615, be reduced if OARs do not meet constraints?
Always protect the brainstem, spinal cord, and chiasm and by that, there will be some compromise of the target. One should not change the target.
Would you offer APBI in a patient with Paget's disease?
If breast MRI followed by central lumpectomy confirms DCIS with negative margins, then I would offer APBI with the same principle as used for DCIS.
What are your recommendations for holding bevacizumab before and after SBRT to the lung?
As @Dr. First Last notes, our experience at Memorial Sloan Kettering has indicated that giving SBRT for ultra-central lung tumors in a patient who has also been exposed to VEGF inhibitors may be an extremely dangerous combination associated with a high risk of fatal pulmonary hemorrhage. This work w...
How do you manage early stage breast cancer in patients who can not have a surgery?
If the patient has life expectancy long enough to consider local therapy, you could consider hypofractionated radiotherapy. The Institute Curie reported 7-year cause specific survival and locoregional control over 95% among 29 early-stage breast patients treated with 32.5 Gy whole breast radiotherap...
Is there any evidence that ivermectin suppresses the PSA level in prostate cancer?
Is this even the right question, though? ADT drops PSA very reliably and yet does not cure patients. Finasteride suppresses PSA, but we do not use it as a mainstay of cancer treatment. Even if ivermectin *did* suppress PSA, unless there is a meaningful oncologic benefit (*at least* reduced recurrenc...
In a patient with a non-operable primary ascending colon mass who has a poor performance status and is unfit for chemotherapy, would you offer radiation therapy as a treatment option?
While there is limited clinical data in the question, it seems this patient is not a candidate for any curative-intent therapy. I would consider palliative RT for pain or GI bleeding, but otherwise would not consider RT a curative treatment option.
How do you approach adjuvant radiation for perihilar cholangiocarinoma?
There should certainly be multi-disciplinary discussion, as while RT can augment locoregional control in the adjuvant setting and should strongly be considered, there is a paucity of high-level data. SWOG 0809 was the first prospective study (single-arm phase 2) of adjuvant therapy in stage pT2-4 or...
Does a pathologic complete response in the breast and axilla change your radiation recommendations?
No. While it is tempting to assume that the chemotherapy has taken care of the local regional disease if there was a pathologic complete response (pCR), we do not yet have good assurance that this is the case. There is an ongoing randomized study testing this hypothesis in patients who have positive...
What are your top takeaways in Breast Cancer from ASCO 2026?
OPTIMA (phase III trial presented by Robert Stein): I think this trial was interesting in that, like Oncotype DX, it supports de-escalation of chemotherapy with lower-risk patients and included pre-menopausal as well as higher nodal burden patients. Omission of axillary dissection from the update...
Is 60 Gy in 40 fractions BID an appropriate regimen to use for LS-SCLC now?
So as to answer the question and not to bury the lede: IMHO, yes.Here's an XRT-style-vs-XRT-style trial showing a survival advantage. How rare is that in radiation oncology? There are probably less than 10 such trials in medical history (wild guess). I can't recall the last time that outright pure d...