Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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...
What are the best radiation therapy options for a young adult with 3 brain metastases from myeloid sarcoma that hasn’t responded well to intrathecal therapy?
The prognosis for young adults with Acute Myeloid Leukemia (AML) experiencing a Central Nervous System (CNS) relapse is generally poor, with most studies reporting a 5-year overall survival rate of ~11%, indicating a very grim prognosis due to the aggressive nature of CNS involvement in AML.The prec...
Under what circumstances would you consider irradiation for brain metastases with active or recent bleeding?
Melanoma and renal cell cancer brain metastases are prone to bleed. When metastases bleed, usually they cause acute symptoms depending on the location within the brain (seizures, sudden onset headaches, acute motor dysfunctions, etc.). These patients are commonly seen in the Emergency Department, at...
What do you recommend to a patient who has biopsy positive DCIS or invasive carcinoma and at time of lumpectomy the pathology is benign (assuming biopsy pathology and post surgical tumor needle localization verified)?
I use the same factors in these cases as I do in any DCIS case with regard to estimating the risk of local recurrence and therefore the benefit of radiation: patient age, DCIS grade, margin status, size of DCIS, and ER/PR positivity. With regard to grade and ER/PR positivity, that information should...
What stomach constraint would you accept in abdominal reirradiation?
For patients with at least one year interval, we reduce the standard GI luminal constraints by 10%. We use a point dose constraint as well as a 40 cc constraint. We almost always use 1.5, 1.8, or 2 Gy per fraction. For example, for 45 Gy in 25 fractions or 39 Gy in 26fx fractions BID, we would allow...
Can palliative radiation be used to treat recurrent malignant pleural effusion in NSCLC?
There has been gradual recognition of improved survival with the administration of three-dimensional radiotherapy (3D-CRT) to the primary tumor in the context of systemic chemotherapy, EGFR-TKIs, or immunotherapy in patients with stage IV non-small cell lung cancer. (Zheng et al., PMID 31040256, Arr...
Would a longstanding diagnosis of multiple sclerosis impact your radiation recommendations for a patient with breast cancer?
In my opinion, the simple answer is no. At least not in my experience treating one MS patient with whole breast radiation. Unlike Scleroderma, which is an autoimmune disease that can result in inflammation and thickening of the skin, connective tissues, and internal organs, MS is an autoimmune disea...
For biochemical failure following prostatectomy, is there a PSA value that would be considered too high to offer local salvage radiotherapy?
While I don't advocate an absolute PSA cut-off for offering salvage RT, the evidence would suggest that the higher the PSA, the lower the chance of success, especially for higher grade tumors. Patients with PSAs above 2 or so appear to have a poor prognosis with RT alone, but I would not consider th...
In a patient with pancreatic cancer who is heterozygous for the ATM c.875C>T (Pro292Leu) mutation with functional impairment in the gene product, is there any data or recommendation to support using SBRT vs. chemo-RT?
Ablative-dose radiation (100 Gy BED) is a curative option, with LC and OS similar to surgery. Everything else is palliative. 50 Gy in 5 fx with MRgRT is an evolving standard. The patient should be informed that this option is available at many centers. Otherwise, any palliative dose is fine. With th...
Would you consider RNI in a patient with axillary recurrence after lumpectomy, whole breast RT and cavity boost 10 years ago?
This patient has residual nodal disease after neoadjuvant chemotherapy and has a high risk of recurrence. I have typically treated the supraclavicular fossa and at risk axilla using a VMAT technique to limit skin dose in the area of overlap. You have 10 years of repair and the patient should tolerat...