Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you consider re-irradiation for a prostate local failure for a patient who initially received standard fractionation with a focal SIB to 95 Gy, or a SBRT boost with cyberknife after EBRT?
In general, I am not an advocate of re-irradiation for prostate cancer, and I am especially not an advocate of re-irradiation in settings where very high dose boosts have been delivered previously, such as focal SIB, SBRT, or brachytherapy. In this situation, you have demonstrated pretty conclusivel...
What is the role of radiotherapy in medically inoperable, large and or recurrent aggressive basal cell or squamous cell cancer of the skin in high risk areas?
When treating small to moderate size skin cancers in an area with good circulation (face, trunk, upper extremity) my standard regimen for BCC is 4500 cGy in 15 fractions, and for SCC I use 4800 cGy in 16 fractions. For large tumors I use 5000 cGy in 20 fractions for both histologies, and this is als...
What adverse features would prompt you to give post-TORS radiation therapy to completely resected early stage (T0-2) p16+ tonsillar cancer?
I would base my recommendation on the standard and conventional indications for PORT, which in this case of an early-stage primary tumor with negative margins, would comprise the presence of PNI, LVI, close (<3-5 mm) margins, single node >3 cm, or multiple positive nodes. I assume there is no extrac...
Do you hold anticoagulation prior to LDR or HDR prostate brachytherapy?
Yes, we have an algorithm for holding prior to brachytherapy/spaceoar/fiducial placement and the patient generally resumes 2-3 days later when they do not notice any blood from urine/bowel. We have a recommendation for each agent. Here are some general examples. Indocin and voltaren: 1 day prior t...
How would you approach treatment of an unresectable paraspinal chondrosarcoma causing cord compression?
For unresectable chondrosarcoma, RT is usually recommended. If conventional fractionated regimens (1.8-2 Gy per fraction) are used, RT of over 70 Gy will be needed to control the disease (per NCCN). In recent years, a limited number of published studies evaluated SBRT (5 fractions) for chondrosarcom...
How do you manage intradural - extramedullary metastases of the spinal cord from non-CNS malignancies?
The optimal approach to treatment of intradural-extramedullary (IDEM) metastases of the spinal cord from non-CNS malignancies usually requires a multidisciplinary approach and is also a function of several factors; The histopathology of the disease (is the disease radiosensitive?) The location of t...
How would you treat a BRAF WT metastatic melanoma patient with leptomeningeal disease in the frontline setting?
LMD from melanoma carries a dismal prognosis (weeks to a few months of survival), depending on how symptomatic the patient is from the increased intracranial pressure. Please refer to a case report I published a while ago with Dr. Ahmad Tarhini from Moffitt Cancer Institute for a discussion of this ...
What dose do you prescribe when treating the prostate in patients with low metastatic burden and what are your dose constraints?
I follow the STAMPEDE regimen - either 55 Gy in 20 daily fractions or 36 Gy in 6 weekly fractions. One of the imperatives of the STAMPEDE investigators was to not subject men with low volume metastatic prostate cancer to toxicity - and they found these doses of did not, while still significantly imp...
Do you recommend salvage radiation therapy to limited recurrent Ewing's sarcoma bony lesions?
Depending on the age of the patient, size, and location of the tumor, SBRT is often an attractive option for re-irradiation for a limited volume recurrence from Ewing sarcoma that failed to respond to prior conventional treatment. There is data from Mayo Clinic (Brown et al., PMID 25548538) and MSK ...
What are your top takeaways from SGO 2025?
Results from the NRG Oncology GOG-0263 phase III clinical trial testing the addition of cisplatin-based chemotherapy to adjuvant radiotherapy following radical hysterectomy for patients with early-stage, intermediate-risk cervical carcinoma indicated that the addition of chemotherapy did not improve...