Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you treat encapsulated papillary carcinoma of the breast after lumpectomy with negative margins?
Encapsulated papillary carcinoma behave like DCIS and we use the same principles as we would use for managing DCIS.
When do you recommend postoperative radiation therapy for a ureter carcinoma?
The role of postoperative radiotherapy for ureteral cancers (and, by extension/association renal pelvis cancers) is controversial. Patients who might stand the most to benefit from adjuvant radiotherapy are those with locally advanced disease; unfortunately, these patients have a high risk of distan...
Would you hold cabozantinib for radiation therapy, or is concurrent use safe?
Cabozantinib is a VEGFR-TKI which potentially carries a risk of hemorrhage and bowel perforation when given together with high dose RT or SBRT though, tangible data are lacking. We will typically hold the drug for 3 days before starting SBRT and will resume 3 days after SBRT (not evidence-based).
What are your top takeaways in GI Cancers from ESMO 2025?
The new results from CheckMate 8HW confirmed an ORR of 73% vs 61%, with a “not reached” median duration of response. Importantly, I note that the time to response is 2.8 months. The confirmed and updated PFS at 4 years is 64% vs 49%. The OS at 4 years is 78% vs 65%. BREAKWATER at ASCO 2025 cemented ...
How do you approach and manage anorexia and appetite loss in people with advanced cancer?
Anorexia/cachexia is often distressing to patients and families and it is this distress that is the target of many of the interventions for this syndrome as there are, in general, no effective therapies. Patients and families are routinely battling over the lack of eating as this causes further disc...
How do you manage a patient with a 3.5 cm squamous cell carcinoma of the perianus (with no involvement of the anal canal) with a positive inguinal node?
Like an anal canal
What is your approach to a completely resected WHO grade II meningioma?
Any attempt toward a definitive answer to this question will at best be too cursory and at worst will jar Pandora’s box, but let’s give it a shot. How to optimally approach patients following gross total resection (GTR) of a WHO grade 2 meningioma remains sufficiently uncertain that 2 randomized tri...
Can SRS be used to treat an atypical meningioma?
I agree with @Dr. First Last, and approach patients with atypical meningioma in the same fashion, preferring IMRT to SRS. Indeed most publications have used fractionated external beam therapy, but several centers have published results with SRS. I encourage anyone to have a close look at these. The ...
How do you manage a stage I LLL medically inoperable lung cancer in close proximity to the stomach?
This is a rare but not uncommon problem (or maybe unusual but not infrequent...). There’s a couple ways to approach this, depending on the tools in your department‘s toolkit. These low lying LLL lesions are ones that I always treat with breath hold (or gated if you have that). You could also look at...
How would you approach local therapy (surgery or RT) in a patient with radiographic complete response after chemoimmunotherapy for non-small-cell lung cancer?
Only 1/96 patients (0.6%) of patients on CheckMate 816 had a complete response by RECIST so I don't think our current paradigms are really driving these kinds of responses. Additionally, there is clearly a disconnect between clinical response rates by RECIST (0.6%) and pathologic complete response (...