Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you recommend SBRT for locally advanced pancreatic adenocarcinoma invading the stomach s/p multiple rounds of chemotherapy?
It is important to be honest with patients about the outcomes of the treatments you were offering. Putting patients at risk for bleeding for something that has no benefit has to be discussed frankly and openly with them. The use of low-dose palliative SBRT does not improve survival over chemotherapy...
Is 80 Gy/40 Fx + ADT the new standard of care for definitive radiation of high risk prostate cancer?
For those who want a more thorough answer, enjoy. If you want you can skip to the end for the summary: For well over a decade, we are taught that dose escalation improves biochemical control but not overall survival, while ADT improves both. Do the results of GETUG AFU-18 change this? Let's take a l...
Would you offer re-irradiation LDRT for someone with osteoarthritis or tendinitis if symptoms recur?
I have not personally offered a patient a third round of LDRT and do not know of any data that shows efficacy. However, I might offer a third round if a particular patient got adequate results with the first two and there was some separation in time (perhaps >1 year) since the last round.
Are you comfortable combining palliative radiotherapy with capivasertib/fulvestrant?
Yes. Follow CBC
If a patient with initially borderline resectable pancreatic cancer receives neoadjuvant CHT followed by CRT and is ultimately deemed unresectable, do you consider an RT boost?
I am careful not to give low-dose preop radiation to someone who might not have surgery. We have done a prospective trial to show that surgery is safe after an ablative dose (Reyngold et al., IJROBP, 2025). There is no published evidence that a boost after a two-month break will be helpful or safe, ...
Is there a role for re-irradiation of a recurrent keloid?
The answer is yes.We follow the dose schedule as highlighted in this review by Dr. Flickinger.Flickinger, PMID 20472370.
How will you select patients with brain metastases for TTFields?
The METIS trial restricted eligibility only to patients with brain metastases from non-small cell lung cancer. Therefore, we would not be able to extrapolate these results and data to other tumor types and histologies. Indeed, a post hoc analysis of the data did demonstrate a greater impact in patie...
Would you offer SBRT for primary pulmonary adenoid cystic carcinoma in a patient who was medically not a surgical candidate?
Obviously, a data-free space given the rarity of this disease state. I have routinely utilized SBRT for oligoprogressive lung metastases from adenoid cystic carcinoma with excellent safety and efficacy, and think this is readily extrapolated to a primary ACC of the lung. There are very limited serie...
How do you account for dosimetric contributions from 177Lu-PNT2002 when planning SBRT?
This is challenging and will be a timely question. In this specific trial, we did perform timed SPECT/CT scans after 177Lu-PNT2002 to try to compute dose to various OARs (and tumor). It is difficult to model this, but there are some published references that allow one to estimate the dose contributi...
Do you ever prophylactically treat an asymptomatic bone metastasis to prevent or delay risk of pathologic fracture?
Yes, this is a situation I have encountered before and I think it is very reasonable to deliver prophylactic RT if there is cortical thinning indicating fracture risk, or if there is documented growth of the metastatic lesion, even in the absence of any symptoms to palliate. Another situation in wh...