Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do more fractionated regimens reduce severe toxicity over SBRT in patients with ILD and early-stage NSCLC?
I personally think fewer fractions are safer, such as 30 Gy x 1 instead of 10 Gy x 5, for patients with advanced COPD or ILD. Why? It's because each time a burst of ionization events is delivered to pulmonary tissues, a wound is created that recruits an inflammatory response, which can exacerbate th...
How would you boost a high-risk prostate cancer patient who received standard fractionation treatment and is not able to get LDR boost given COVID-19?
I will assume for the sake of argument that he is also getting ADT as part of his treatment. If he has responded well to ADT (I like to see about a 90% drop in the PSA within 3 months), my preference would be to try to delay until it's reasonable from an infectious disease perspective to proceed wit...
What are the current official guidelines regarding managing patients during COVID-19?
Here are some guidelines and FAQ from professional societies: NCCN: https://www.nccn.org/covid-19/default.aspx ASTRO FAQ: https://www.astro.org/Daily-Practice/COVID-19-Recommendations-and-Information/COVID-19-FAQs ASCO Coronavirus Resources: https://www.asco.org/asco-coronavirus-information
What are your top takeaways in thoracic cancers from ESMO 2025?
I think that the data regarding Sac-TMT vs. frontline platinum chemotherapy was the most impactful data. With all of the caveats of a China-only study, this is the first time that we have seen an ADC demonstrate a survival advantage in this setting. The other two presentations are less novel, but t...
Would you use CT planning to treat a large keloid of the scalp post operatively?
We use a CT sim for almost all keloids, especially those where complex planning may be needed.Depending on the size and shape, you can even consider more complex treatment approaches, as noted in this case report: Ilori et al., PMID 35755175.
How will the results of NRG GU006 and the use of the PAM50 genomic classifier impact treatment for recurrent prostate cancer?
Top line results: The prostate cancer-adapted PAM50 gene expression biomarker was validated in the NRG GU006 randomized trial to predict the differential benefit of hormone therapy, specifically apalutamide monotherapy, for patients with recurrent prostate cancer after radical prostatectomy being tr...
How would you approach the treatment of low grade, stage IA, triple negative apocrine adenocarcinoma of the breast in a female patient in her 70s?
I would not treat this the way I would a typical triple-negative breast cancer, since the risk of distant recurrence from occult metastatic disease is low. Assuming she had breast-conserving surgery, radiation, favoring partial breast, is reasonable. In terms of systemic therapy, if the cancer in th...
How would you manage BCC to the left cheek after only half of a radiation course was completed three months ago and non-operative management is preferred?
An assessment of three domains is going to help the patient and physicians in this case: Patient related factors: A medical emergency that lasts three months implies a lot-- so what is the performance status of the patient now and what is the prognosis; because an ECOG 3-4+ patient with new onset mu...
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 ...
Which patients, if any, do you offer transdermal estradiol as a method of ADT instead of LHRH agonists?
My default form of ADT remains a GnRH agonist or antagonist but estradiol transdermal patches are clearly effective and safe as an alternative option for men who either 1) have significant loss of bone density/osteoporosis, 2) have significant hot flashes with traditional ADT and wish to try an alte...