Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Which imaging modalities and schedule do you use to follow stage I-II follicular lymphoma that was treated with radiotherapy alone?
PET has been demonstrated to be more sensitive and specific in staging for FL as well as a strong independent predictor of outcome after treatment. Patients also have ~50% risk of developing recurrence outside the RT volume - and PET allows for whole-body imaging. PET is therefore the imaging modali...
Does the presence of interstitial lung disease (excluding IPF) affect your decision to offer conventional fractionated RT for Stage III NSCLC?
Tough question. I think a key step would be how certain the diagnosis of ILD is. I.e., was this a comment incidentally on a CT scan from radiology, or does the patient have active ILD management by a pulmonologist? Certainly, UIP patients appear to have higher rates of severe toxicity following RT. ...
How do you decide timing of adjuvant radiation with respect to chemotherapy for a patient with resected pancreatic adenocarcinoma with microscopic positive margins?
Level 1 evidence supports chemotherapy, FOLFIRINOX is the standard. The benefit of radiation is modest in comparison and based on post-hoc analysis of phase III trials (ESPAC-1, and others that are themselves nearly uninterpretable). The answer to this question is chemotherapy followed by restaging ...
Would you offer adjuvant radiation in addition to chemotherapy for a patient with stage IIIC uterine carcinosarcoma with cervical involvement?
This is a hard situation as there is no clear data for the exact treatment plan. For surgically staged patients with stage IIIC uterine cancer our tumor board treatment plans typically include discussion of PORTEC-3 (de Boer et al., PMID 31345626) and GOG-258 (Matei et al., PMID 31189035). Patients ...
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.
How do you follow/manage patients with metastatic prostate cancer with undetectable PSA and castration-sensitive but active disease on PSMA PET?
Summary: This is a challenging clinical scenario, and one in which I think there is currently a lot of practice variability. In such cases, I would not jump to action immediately, and I would first try to obtain some additional information. This would include repeat PSA for confirmation as well as f...
How soon after SpaceOAR placement can radiation planning CT be performed?
At Univ of Utah, we serve a geographic footprint equivalent to 20% of the United States. As such, many patients travel from 100s of miles away from therapy at our center. We put in spacers, and perform CT simulation on the same day (usually 2 hours apart). Never noticed any significant issues with d...
How do you manage prostate cancer in patients that cannot swallow pills?
The only one suitable for feeding tube administration is apalutamide (must be 8 French or greater feeding tube size). My oncology pharmacist suggests tablet(s) can be placed in a syringe (whole, not crushed), distilled water then added, shaken vigorously to disperse contents, administered through...
What are your top takeaways in Head & Neck Cancers from ASCO 2025?
ASCO 2025 had several interesting abstracts for head and neck cancers. The following abstracts could reshape the landscape of locally advanced head and neck squamous cell carcinoma by finally showing improvement in outcomes with PD-1 inhibitors in the curative setting. Hopefully, these trials mark t...
What are your top takeaways in Gyn Cancers from ASCO 2025?
We had some exciting abstracts for ASCO 2025! These gynecologic oncology abstracts highlight some truly impactful advancements. Here's a concise breakdown of the key findings and their potential implications: 1. CALLA Trial – ctDNA Detection in LACC (Abstract #5502, Dr. Mayadev et al.)Study Focus: E...