Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What do you tell patients that opt for High-intensity focused ultrasound (HIFU) for favorable intermediate risk prostate cancer over AS (Active Surveillance), RP (Radical Prostatectomy), EBRT (External Beam Radiation Therapy), or brachy?
Urology and radoncs differ in their approach to this. Recent (inflammatory) social media discussions have shown this. There are limited prospective data on focal therapies versus whole-gland approaches, but the retrospective data should give us all pause. What we do know: HIFU has significant toxic...
When should you use single-fraction radiotherapy for spinal cord compression?
The SCORAD III trial is practice changing. But I do NOT plan to treat ALL patients with spinal cord compression with a single fraction of 8 Gy now. Here is why: SCORAD III is extremely important new study for the management of metastatic epidural spinal cord compression (MESCC) for patients with sho...
What is the preferred palliative regimen for elderly patients with rectal cancer who elect to forego surgery?
This is a question that comes up somewhat frequently and I don't believe really has a definitive answer. I myself have used multiple regimens in this situation. I think it really depends on the performance status and life expectancy of the particular patient. This is also a topic that may bring out ...
Are you altering your use of Active Breathing Coordination for breath hold technique patients in light of the COVID-19 pandemic?
We use DIBH, and this has not changed anything in our practice.
What radiation dose would you use for T4 prostate cancer?
Local therapy for T4 prostate cancer is critical. It needs to get the full dose to ensure good control. There is very little information about the specifics of the radiotherapy, and I don't believe there is any toxicity data specifically for cT4 lesions. However, there is data showing local therapy ...
For patients with cT1-T3 cN0 cM0 mid/low rectal cancer seeking organ preservation, what treatment approach do you recommend?
This is an important question; however, the answer is unknown. The key outcome that should be the focal point for the best treatment option, is which treatment strategy results in the most optimal patient reported quality of life and bowel function. Currently, this remains void of prospective, rando...
Would you consider the thymus as an OAR during treatment planning for advanced NSCLC?
Personally, I'd like to see these findings reproduced in at least two other retrospective studies before I would consider them real. If validated, it's time for more radoncs to use the D2cm and R50 tables when designing IMRT plans to clamp down on intermediate doses that might otherwise spill into t...
Do you recommend placement of a rectal spacer when delivering radiotherapy to the prostate in patients with oligometastatic prostate cancer?
No. I have had a few patients seek it out on their own, which is fine. But I tell them it is not necessary.
How long after achieving a CR would you consider stopping pembrolizumab in metastatic melanoma?
Based on Keynote 001 and more recently on Keynote 006, where we observed sustained remission in more than 90% of the patients who had stopped pembrolizumab for complete response, we usually consider stopping pembrolizumab in patients who have a confirmed complete response (this means that we have tw...
How do you approach treatment of a glioblastoma in pregnancy?
Glioblastoma during pregnancy could be treated safely (to mother and fetus) with certain precautions and modifications. Collaboration and consultation with the patient’s obstetrician are essential. External shielding over the patient’s abdomen during treatment will decrease the external scatter radi...