Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is there a role for induction chemotherapy for locally advanced head and neck squamous cell carcinoma prior to definitive chemoradiation?
Induction chemotherapy can be considered in some patients with locally advanced SCCHN, primarily those patients with large bulky tumors who are at highest risk for developing distant metastases. Moreover, if you are looking to attain reduction in tumor bulk for symptom control and possibly control o...
Given the long half-life of dexamethasone, what is an appropriate dose schedule?
After a discussion years ago with my fellowship-trained Neuro-oncologist friend (from Neurology track), I use dexamethasone only ever on a qam schedule. It doesn’t disrupt the sleep as much, there’s no waking for doses, the schedule is easy for patients and families to remember. In seven years of pr...
Do you offer consolidation durvalumab in a patient who had pneumonitis requiring steroids following chemoradiation for LS-SCLC?
In the ADRIATIC trial, pneumonitis or radiation pneumonitis occurred in 38.2% of durvalumab-treated patients, and 8.8% discontinued treatment due to pneumonitis (Cheng et al., PMID 39268857). While there is emerging interest in immune checkpoint inhibitor rechallenge after successful management of i...
Should a patient who requires definitive treatment for prostate cancer as a pre-transplant requirement be strictly required to complete their course prior to transplant/initiation of immunosuppression?
To help address this complex question, I would like to call your attention to a review of the topic by Al-Adra et al., PMID 32969590. It covers several types of malignancies, including prostate cancer (Table 4). Treating this patient will require close collaboration with the transplant surgeon, urol...
What are your top takeaways in GU Cancers from ESMO 2025?
KEYNOTE-905: These impressive results change the management paradigm of patients with MIBC who are surgical candidates but are not cisplatin-eligible. Over time, it may be that EVP perioperative therapy becomes the standard of care for all patients with MIBC with plans to proceed with cystectomy. I...
When do you add a third field for IMPORT-LOW style partial breast irradiation?
I don’t usually use the 3rd field and treat with min tangent with FIF to improve homogeneity. If planning to do conformal RT then prefer an APBI dose of 30 in 5 with VMAT technique.
What is your approach for a primary tracheal squamous cell carcinoma?
First off as you probably know this is a randomized data-free zone. So to some extent what to do here is empiric and/or based on historic outcomes, retrospective data, and so on. But here are a few quick & dirty observations...1) Surgical patients have the best survivals/outcomes. Doing tracheal sur...
What is the best IGRT strategy in treating the prostate bed (adjuvant or salvage): Daily anatomy KV images vs. fiducial seed kv images vs. CBCTs?
For our post-prostatectomy men, we use daily kV and line up to surgical clips if available (contouring out a clip each quadrant of the prostate bed if possible) with a PTV expansion of 5 mm. If clips are not present, then we use CBCT to evaluate soft tissue alignment and use a slightly larger PTV of...
What is the current paradigm for breast cancer diagnosed with isolated metastases prior to initial treatment?
Surgery of the primary did not significantly improve overall survival in which patients were randomly allocated to receive systemic therapy alone or (for responding patients) to systemic therapy followed by primary tumor resection in the trial conducted by ECOG-ACRIN (Khan et al., PMID 34995128), at...
What constraints do you use for the BID small cell lung cancer regimen?
The best validated constraints are from CONVERT (CALGB 30610/RTOG 0538). Cord D0.1cc < 41 GyEsophagus mean < 34 GyHeart V60 < 33%Heart V45 < 67%Heart V40 < 100%Lung V20 <40%Lung mean < 20 GyAlthough I tend to push for the LU005 constraints which I think are slightly more conservative.In addition to ...