Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you interpret recent large retrospective analyses comparing radical prostatectomy vs. radiation for prostate cancer?
There have been numerous comparisons of RT vs. RP from a variety of study teams with various conclusions, and it often seems like the principal conclusion of the study is best predicted by the subspecialty from which the authors originated (urology vs. radiation oncology). As the question partially ...
Are there any contraindications to Pluvicto therapy you personally use, given that there are none directly provided by the manufacturer?
In this situation, it is helpful to review the eligibility and exclusion criteria from the VISION protocol directly. These can be found at NCT03511664 (Sartor et al., PMID 34161051). Many of these patients have been heavily pretreated, including prior taxane therapy, so my main concern is that they ...
In which patients do you utilize a breast MRI as part of the initial workup for breast cancer?
I'm not a fan of routine MRI in the work-up for early-stage breast cancer, but I do agree with the fairly standard list of selective indications mentioned previously. I also obtain an MRI when there is a significant discrepancy between standard imaging and physical exam. Examples would be: One or a...
How, if at all, have you incorporated GLP-1 agonists into your fertility-sparing management of patients with EIN or endometrial cancer?
While ultimately not a fertility-sparing use, we have begun to use GLP1s in conjunction with dietetic consult, weight loss medicine, and exercise in an attempt to convert patients with medically inoperable endometrial cancer to operability when the only major contraindication is morbid obesity in yo...
How are you using ArteraAI in 2026 for intermediate risk patients?
I use both ArteraAI and Decipher to help with these decisions. As Dr. @Dr. First Last says, it's post-hoc based on large datasets. Artera claims to be predictive, while Decipher is just prognostic. Without going through all the data, I find it helpful for intermediate risk, where it is on the cusp o...
Do you offer consolidative radiation for oligometastatic breast cancer?
I'd like to add a few additional considerations to the already excellent responses from our colleagues. Many of the trials cited actually address two related but distinct clinical questions, and the answer for HER2-positive disease specifically may diverge from the population-level results.Trials of...
What treatment volumes and dose do you use for postoperative soft tissue sarcoma of the scalp with negative margins?
While there is institutional variation in practice, our standard has been to extend extremity/trunk paradigms to the head and neck region, including the scalp. For negative margins for a scalp sarcoma, we typically use margins of 3-3.5 cm for CTV for the first course and then 1.5-2 cm CTV for the co...
Do you offer palliative whole liver radiation for patients with diffuse liver metastases?
Whole liver radiation is a very good palliative treatment for diffuse hepatic metastases causing pain or severe nausea/vomiting. I treat the whole liver plus a 1 cm margin to 7-8 Gy/1 fraction per the Phase II trial from Princess Margaret Hospital (Soliman et al., PMID 24062394). In this trial of 41...
What SBRT dose would you give to a single external iliac lymph node recurrence (1 cm size) for a patient previously treated with salvage radiation to the pelvis?
35 Gy/5 is fairly safe in the re-irradiation setting, and in our experience, it's quite effective for nodal disease.
What is the rationale for the recent change in the NCCN criteria for very high risk prostate cancer?
As the new Chair of NCCN's Prostate Cancer Guidelines, I am happy to answer this.The purpose of risk groups is not merely to be a prognostic divider, but to help guide treatment. Many systems have been developed that have greater prognostication than NCCN risk groups, such as STAR-CAP (which is supe...