Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What planning and dose constraints are you using for 5-fraction hypofractionated FRST for vestibular schwannoma?
When using fractionated SRS (fSRT) of 25 Gy in 5 fractions for vestibular schwannomas, I use only 2 constraints: the brain stem and the cochlea, if the patient has serviceable hearing. In this case, the only OAR needed is the brain stem, 23 Gy <0.5 cc. I don't worry about the trigeminal nerve as it ...
What is the appropriate amount of time to allow for wound healing prior to post-operative radiation for metastatic disease?
I typically have waited about 4 weeks or so to start RT after ORIF. In addition to limiting risk of wound complications, this allows time for the patient to adequately recover from a pain perspective, since if one tries to treat earlier, the tolerance of treatment is often poorer. In situations wher...
Would you omit pelvic XRT in a high risk prostate patient with negative nodal uptake on PSMA but has risk of nodal involvement >15% by nomogram?
Based on POP-RT, if they are a high-risk group, I would add pelvic RT.
How do you counsel patients/families whose goals of care are clearly aligned with a comfort-focused, end-of-life approach, but who are hesitant to formally enroll in hospice?
Hospice sounds like a 4-letter word to a lot of families! I find it important to distinguish the philosophy of comfort care vs. the benefit package associated with enrolling in hospice. Some people are able to be provided end-of-life comfort care without electing the hospice benefit, and that is fin...
Do you ever perform adaptive replanning for interfraction tumor volume changes appreciated during a fractionated SRS (5 fx) treatment for CNS metastases?
I have done adaptive re-planning in the past for tumors that had obviously grown based on CBCT (i.e., intraventricular metastases) from the time of sim to treatment for LINAC-based SRS. I think certainly in the other situation (i.e., obvious decline in size of tumor where one is quite confident base...
Do you routinely cover the laminectomy site when treating with spine SBRT?
I have never covered the laminectomy incision site with spine SBRT and would worry about the risk of wound complications in doing so. I have not personally seen laminectomy site recurrences [I do follow patients closely with clinical and radiographic (MRI) surveillance following post operative spine...
For ALK+ patients rendered NED from oligometastatic NSCLC after resection of both lung primary and isolated CNS lesion, do you consider offering treatment with an ALK inhibitor after adjuvant chemotherapy, or do you place into surveillance?
A large proportion of patients with oligometastatic disease managed with curative intent generally relapse, either intracranially and/or extracranially. TKI therapy maybe expected to prolong disease-free/progression-free survival based on our experience with EGFR TKIs. However, given the expected du...
Do you see MR Linac having a role in the treatment of CNS disease?
MR Linac has a lot of potential in the management of CNS neoplasms. To best understand its potential, it is critical to understand what the genuine value proposition of the MR Linac really is. At its heart, and rather simplistically, many view it as simply another option for image guidance to suppor...
What are your top takeaways in Thoracic Cancers from ASCO 2026?
At the ASCO 2026 meeting, two important trials on NSCLC were presented in the Plenary Session that may have a significant impact on future management in these patient populations. Phase III LIBRETTO trial- 432: Presented in this year's ASCO Plenary Session. This trial included NSCLC with a RET fusio...
What activity restrictions do you counsel patients on after radiosurgery for arteriovenous malformations, given the continued risk of hemorrhage until nidus obliteration?
Prior to radiosurgery for an arteriovenous malformation, I counsel patients that the risk of hemorrhage is not immediately eliminated by treatment and may persist until the nidus is completely obliterated, which can take several years. Therefore, posttreatment follow-up and clinical surveillance rem...