Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you offer consolidative thoracic radiation for oligometastatic NSCLC following upfront immunotherapy?
Yes, I do offer consolidation in patients with oligometastatic lung cancer after immunotherapy. Like @Dr. First Last, often these patients are referred to me at "oligoprogression," when one lesion progresses (often the primary or largest site), but most minor lesions appear to be under control. The ...
Would you favor post op radiation therapy for soft tissue sarcoma if a positive margin were still expected despite pre-op radiation?
The key question here is whether you are dealing with tumor ON the plexus, expected to result in a microscopically positive (R1) margin, or tumor IN the plexus, expected to result in gross residual disease (R2). If tumor is ON the plexus, a planned R1 margin on a critical structure, with addition o...
How do you approach cisplatin dosing for locally advanced head and neck SCC in HPV-positive and HPV-negative patients?
Weekly cisplatin 40 mg/m² is not yet considered equivalent to high-dose cisplatin 100 mg/m² every three weeks, and high-dose cisplatin remains the preferred regimen for both HPV-positive and HPV-negative locally advanced head and neck squamous cell carcinoma. However, weekly cisplatin is an acceptab...
Do you recommend treating pre-chemo volumes to full prescription dose for locally advanced nasopharyngeal cancer following induction chemotherapy?
I think it is reasonable if the purpose of the chemo was to shrink the primary away from OARs like the optic chiasm. Obviously, as @Dr. First Last says, if the tumor was exophytic, you don't need to treat the air. However, I would still include in my high dose CTV the pre-chemo routes of spread, e.g...
How do you treat encapsulated papillary carcinoma of the breast after lumpectomy with negative margins?
Encapsulated papillary carcinoma behave like DCIS and we use the same principles as we would use for managing DCIS.
What's the role of contralateral neck re-irradiation in the post-op setting for someone with a remote history of head and neck cancer who underwent definitive RT with elective dose to the bilateral neck now with a new primary s/p surgery with ipsilateral neck dissection requiring post op chemo radiation for bony involvement and ENE?
In a reirradiation setting, I would not offer elective RT. Even if the new primary approached or crossed midline, I would refrain from reirradiating a neck that was subject to prior RT in the 50 Gy range.
What is the role of adjuvant radiation therapy for stage III melanoma in the era of adjuvant Opdivo?
I think the role of adjuvant radiotherapy in stage III cutaneous melanoma is difficult to define at this time (June 2019). To be clear, the TROG trial mentioned above showed that adjuvant lymph node basin radiotherapy after therapeutic lymphadenectomy can decrease the chances of lymph node basin dis...
When do you recommend postoperative radiation therapy for a ureter carcinoma?
The role of postoperative radiotherapy for ureteral cancers (and, by extension/association renal pelvis cancers) is controversial. Patients who might stand the most to benefit from adjuvant radiotherapy are those with locally advanced disease; unfortunately, these patients have a high risk of distan...
Would you hold cabozantinib for radiation therapy, or is concurrent use safe?
Cabozantinib is a VEGFR-TKI which potentially carries a risk of hemorrhage and bowel perforation when given together with high dose RT or SBRT though, tangible data are lacking. We will typically hold the drug for 3 days before starting SBRT and will resume 3 days after SBRT (not evidence-based).
What are your top takeaways in GI Cancers from ESMO 2025?
The new results from CheckMate 8HW confirmed an ORR of 73% vs 61%, with a “not reached” median duration of response. Importantly, I note that the time to response is 2.8 months. The confirmed and updated PFS at 4 years is 64% vs 49%. The OS at 4 years is 78% vs 65%. BREAKWATER at ASCO 2025 cemented ...