Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What are your top takeaways in Breast Cancer from ASCO 2025?
My Top 3 takeaways in Breast Cancer from ASCO 2025 ASCENT-04: Sacituzumab Govitecan Plus Pembrolizumab as a New First-Line Standard for Metastatic PD-L1-Positive Triple Negative Breast Cancer (TNBC): The treatment landscape for metastatic TNBC continues to evolve rapidly. At ASCO 2025, presentation ...
What are your top takeaways in GU Cancers from ESMO 2025?
KEYNOTE-905: These impressive results change the management paradigm of patients with MIBC who are surgical candidates but are not cisplatin-eligible. Over time, it may be that EVP perioperative therapy becomes the standard of care for all patients with MIBC with plans to proceed with cystectomy. I...
Would you omit radiation for an elderly woman with bilateral breast cancers (both early-stage disease and ER+/PR+/HER2 negative) who otherwise meets the criteria for endocrine therapy alone?
Yes. If the patient meets omission criteria on each side individually, then I offer omission to the patient overall as part of shared decision-making, although it is conceivable that the absolute benefit of radiation is doubled in this scenario. As usual, this assumes the patient will be compliant w...
What are your top takeaways in Head & Neck Cancers from ASCO 2025?
The phase 3 KEYNOTE-689 and the phase 3 NIVOPOSTOP. A key distinction is that KEYNOTE-689 incorporated both neoadjuvant and adjuvant immunotherapy, while NIVOPOSTOP restricted immunotherapy to the adjuvant phase and specifically targeted patients with high-risk features (+ margins and ECS) post-surg...
How do you manage bladder spasms during pelvic radiotherapy?
My approach would depend on the disease under treatment, specific symptoms, concurrent therapies, and whether or not the patient has a prostate. The first thing I would do, if you have not already done it, is obtain a urine sample to rule out infection. Let's assume that was done and there is no inf...
Would you offer re-irradiation for a prostate local recurrence after I-125 seed implant >10 years ago in a healthy young patient with life expectancy >15 years?
While I think salvage re-irradiation does have the potential to become a routine option in such situations, I think further study is required to define both the efficacy and toxicity profile prior to establishing it as such. The current state of knowledge is based on limited information, as Dr. @Dr....
How should you manage a pediatric oncology patient who has an ANC > 500 and a normal chest x-ray but is confirmed to be infected with COVID-19 and is immunosuppressed from chemotherapy?
The treatment for pediatric patients with cancer who develop COVID-19 is very poorly defined. The risk of severe disease is unknown because although adults with cancer appear to have worse outcomes than those without, non-immunocompromised children seem to have few severe outcomes from the disease a...
Do you attempt to spare the submandibular glands in head and neck IMRT?
I do too. The primaries I consider electively treating 1B nodal station are: oral cavity, nose and anterior nasal cavity, lip, medial cheek/mid face, and node positive parotid. The submandibular gland itself is devoid of lymph nodes and is rarely ever involved by Sq cell Ca (versus the parotid gland...
Is there any evidence for combining surgery and XRT +/- ADT for treatment of localized high risk prostate cancer?
Presumably, this is a question inquiring about planned post-operative RT. If so, surgery followed by adjuvant, post-operative radiation therapy (PORT) has been profiled extensively in several RCTs: EORTC 22911, SWOG 8794, ARO 96-02, FinnProstataX. The two more recent trials, ARO 96-02 and FinnProsta...
For locally advanced rectal cancer, will the recent update of RAPIDO lead you to change your practice when approaching TNT?
We prefer long course chemoradiation followed by consolidation with FOLFOX and non-operative management based on the OPRA trial, which reported 60% versus 40% using this sequence versus initial chemotherapy.