Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you manage a patient with recurrent, high-grade leiomyosarcoma involving the pelvis after salvage exenteration, but who has a focally positive anterior margin?
Ideally, plan for intraoperative radiation or surface brachytherapy at time of surgery.
Do the results and approval based on ADAURA trial suggest a role for adjuvant osimertinib in patients with stage IIIB-C, EGFR mutant patients treated with concurrent chemoradiation?
ADAURA trial was not designed to address this issue. But that being said, we need to remember few things before considering "maintenance durvalumab" in patients with EGFR-mutant lung cancer, following chemo-radiation: 1. EGFR-mutant NSCLC patients may not derive any clinical benefit from single-agen...
How would you approach treatment for a patient with a residual disease after resection of a solitary jejunal myeloblastic sarcoma?
Myeloid sarcoma (historically- chloroma or granulocytic sarcoma) is simply an extramedullary form of AML. The majority of patients who present de novo with a myeloid sarcoma will either have bone marrow involvement at diagnosis or will develop such metachronously if systemic therapy is not pursued. ...
Within what timeframe should adjuvant radiotherapy start for Merkel cell carcinoma of the head and neck region?
I use a 4-6 week post-op timeframe for adjuvant RT for Merkel cell carcinoma. I always prefer closer to 4 weeks, whenever possible.
In patients with advanced endometrial cancer who you plan to treat with chemotherapy + immunotherapy (per GY018 or RUBY), how and when do you utilize adjuvant EBRT and/or brachytherapy?
Reading the question at face value - does advanced endometrial cancer mean stage IVB? III/IVA? If IVB, there is not routinely a role of 'adjuvant' EBRT or BT.Given the discussion of adjuvant therapy, I presume the question is asking for the small fraction of RUBY and GY-018 patients who were stage I...
How would you approach a locally advanced NSCLC s/p pneumonectomy now with multi-station mediastinal nodal recurrence?
Very tough clinical scenario. I routinely say that in an era where we have good options with both peri-op chemoimmunotherapy or chemoradiation followed by immunotherapy, patients with LA-NSCLC shouldn't be getting pneumonectomies (with rare exceptions). Stepping off that soapbox, I'd start with a go...
Would you offer a third course of palliative radiation after two courses of 8 Gy in 1 fx?
There are rarely definitive answers to questions like these, but I’ll do my best to detail some of my thoughts on how I would approach this situation, since I was asked to fill this request. I would usually have a conversation with a patient about the risks and benefits, and then utilize a shared, i...
How would you manage T3N0M0 sarcomatoid carcinoma of the prostate with adenosquamous differentiation s/p prostatectomy?
Sarcomatoid prostate cancer is an aggressive histological subtype. It may be locally aggressive, and post-operative PSA monitoring may be less helpful for this histologic subtype, which interferes with the usual trigger for initiation of salvage RT (Grignon, PMID 14976541). Despite the lack of high-...
How would you treat an elderly patient with metastatic breast cancer with two new progressive right breast/chest wall lesions?
I addressed the question of how to manage patients with symptomatic breast masses in a posting on December 19, 2025. The first question for this patient with progressive lesions is whether they are symptomatic now or not. If not currently symptomatic, then I would likely defer RT until such time as ...
In what cases of T3N0 glottic SCC, would you omit chemotherapy and offer radiation alone?
The question seems to stem from a presentation of a patient that would have historically been stage 2, but more recent editions of AJCC and more refined imaging have upstaged the patient to stage 3 by calling minimal paraglottic extension on an MRI. This is similar to a previous question where a pat...