Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
In light of Aizer et al. data presented at ASCO 2025, what is your threshold for offering SRS/SRT in patients with multiple brain metastases?
Over the past 4 decades, the treatment of brain metastases has been evolving along with advances in technology, from simple whole brain radiation (WBRT) with opposed lateral fields to IMRT-driven treatment (HA-WBRT); similarly, in the field of SRS/SRT, we have pushed the envelope of what we can achi...
What uterine risk factors do you consider when recommending VBT boost after EBRT?
Since most patients who need EBRT now have high risk disease with more than one adverse factor, we prefer EBRT 45 Gy in 25 followed by 5 Gy x 2 for almost all unless the patient declines brachytherapy.
How would you approach an isolated Axumin PET-positive focus in the prostate bed in the setting of rising PSA after prostatectomy and salvage radiation?
In general, I do not offer reirradiation to the prostate bed following salvage radiation therapy, as the risk of causing significant late toxicity affecting the rectum, bladder and tissues of the pelvic floor is high if one were to try to deliver a dose that had a reasonable chance of achieving long...
How would you manage a patient who developed an intraprostatic abscess after SpaceOAR injection, prior to starting radiation?
Rectal spacer complications are rare, but still happen. In a recent review, 0.4% of patients experienced a complication resulting in an adverse event report. 13% of these reports had a CTCAE of >= 3. Some of these adverse event reports (91/981) were abscesses related to SpaceOAR placement (Millot et...
In what situations would you treat with adjuvant radiation for resected gallbladder cancer?
Most retrospective studies have suggested adjuvant chemoradiation may be associated with better survival after resection compared with observation. Frequently identified risk factors for recurrence include advanced T or N stage and positive margins. What isn't known is what specific adjuvant therapy...
Would you offer adjuvant radiation for a patient who is incidentally found to have a pT2b NX adenocarcinoma of the gallbladder after a simple cholecystectomy?
Gallbladder cancer is often found incidentally, so this is a common scenario, but typically happens in around 1% or less of laparoscopic cholecystectomies. The best outcomes are achieved when patients are able to undergo re-exploration and resection, both because patients have a high risk of having ...
In a patient with history of early stage oral cavity cancer and a new ipsilateral neck failure, would you treat the initial site of disease?
At MDA we have for many years followed a guideline for the unirradiated patient with a metachronous neck recurrence from the oral cavity. I say guideline as we have not had ridgid adherence. Our guideline has been 1 year between the initial disease and the recurrence. If less than a year, we treat a...
What is your thought process for dose prescriptions when treating abdominal/pelvic lymph node oligometastasis with SBRT?
I don't love SBRT for nodal mets aside from unique situations. Although I agree they may represent a less aggressive phenotype than hematologic parenchymal mets they are also connected to their neighbors in a way a bone met isn't. SBRT is a very focal therapy when done well and so neighboring LNs do...
What is the maximum time you would allow between simulation/treatment planning MRI and delivered treatment for stereotactic radiosurgery for brain metastases?
All efforts should be taken to have the patient treated as early as possible after simulation. If a delay is inevitable, up to 7 days is acceptable in most situations. However, for patients with melanoma, due to risk of hemorrhage and potential aggressive progression, the delay should be shorter. Pa...
Would you ever omit adjuvant radiation for a patient with rectal cancer originally staged cT1N0, but found to be pT1N1 after surgery?
Certainly a topic that comes up not uncommonly in tumor boards. The gold standard comparing pre to post operative chemoradiation remains the German colorectal trial, and showed increase in acute diarrhea from 12% to 18% and long term GI sx from 9% to 15%, strictures from 4% to 12%. Although there is...