Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you add ADT to RT for a patient with intermediate-risk prostate cancer with discordant Decipher and ArteraAI results?
This will be a long response to try to provide transparency to these tests from what I know as a researcher and clinician. I also clinically see this situation frequently. We have made incredible progress in developing biomarkers in prostate cancer, but it is important to know that no single test is...
Is it reasonable to treat a solitary plasmacytoma of the lung parenchyma with SBRT?
I have only treated one patient with solitary plasmacytoma of the lung over the past 15 years of doing lung SBRT. It is an extremely rare and unusual disease presentation for myeloma. Given the radiosensitivity of myeloma, I opted for 30 Gy in 5 fractions, which resulted in a completed response in t...
Is it necessary to prescribe a steroid taper after two weeks of high-dose prednisone (60 mg daily)?
Interesting question. Not being an endocrinologist, I don't have the expertise to advise but the reference below makes the statement that even short-term steroids can be an issue. I suspect that if you have to stop abruptly from 60 mg daily for 2 weeks, it would probably be fine in most instances bu...
Would you consider ultra-hypofractionated 5 fraction regional nodal radiation in a node + breast cancer who otherwise wouldn't tolerate 16 fractions of RT?
At this time, unless there was a strong reason that hypofractionated breast + RNI in 15-16 fractions couldn't be done, I wouldn't use 5 fx breast + RNI off-trial. If compelling reasons, one could consider extrapolating safety of breast RT from FAST/FAST-Forward and axilla from melanoma data.
How are you modifying your current sarcoma-directed therapy in the setting of the COVID-19 pandemic?
Here are the guidelines at Fox Chase Cancer Center by Margaret von Mehren MD, @Dr. First Last , Jeffrey Farma MD, Sanjay Reddy MD, John Abraham, MD, and Stephanie Greco, MD I. Management of STS during COVID-19 Pandemic: During the current pandemic, care will need to be changed to allow for hospitals...
What are your top takeaways in GI Cancers from ESMO 2025?
1. MATTERHORN StudyThe global phase III MATTERHORN trial enrolled 474 patients with resectable gastric or gastroesophageal junction adenocarcinoma, randomized to receive FLOT alone or FLOT plus durvalumab. The primary endpoint, event-free survival (EFS), was previously reported as positive. Adding d...
How are you using predictive tests such as DCISionRT (PreludeDx) or OncotypeDX DCIS in the management of DCIS?
Advantages: It's a relatively cheap, simple assay to better individualize risk of DCIS. Not only prognostic like Oncotype DCIS but also predictive of the absolute benefit of radiation. Supposed to be a better risk assessment tool than traditional clinical pathologic factors. Can identify those who ...
Is there any consensus or guidance on how to manage germ cell tumor patients in the COVID-19 era?
Germ Cell Tumor Management in face of SARS-CoV-2: Safe, Rational Modifications to Standard GCT Practice to Protect Public Health, GCT Outcomes, GCT Patients, and Health Systems. This bulletin has been produced by a concerned group of international experts in germ cell tumors, has not undergone exten...
Should we be stopping new starts of patients who can be triaged for 2-3 months like prostate cancers on ADT when significant community spread of COVID-19 is detectable in our area?
I would for those patients requiring ADT, which is the way I interpreted the question. I want to elaborate more because @Dr. First Last brought up other scenarios we should consider and he brings some more good points: Many patients could get active surveillance for a period of time before ADT is co...
Would you perform unilateral or bilateral hippocampal avoidant whole brain RT in a patient with a prior SRS to a small hippocampal metastasis?
I would recommend bilateral HA-WBRT and memantine in this situation. The role for HA-WBRT is shrinking over time with a diminishing patient population between the expanding role of SRS for multiple brain mets and no role for cranial RT for poor prognosis patients with no/limited systemic therapy op...