Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you counsel patients on imaging findings after liver SBRT for HCC, particularly with regard to expectations on timing to tumor resolution?
My experience has been that the more successful the treatment, the sooner the patients want the good news. In reality, a well-designed and executed SBRT treatment to an ablative dose should result in 85 to 95% tumor control (mostly size independent) at 2 years with very little local progression afte...
How do you manage dry eye syndrome due to lacrimal or meiobian gland dysfunction after external beam radiotherapy?
I have also found autologous serum (AS) or platelet-rich plasma (PRP) eye drops/tears to be extremely useful (provided by an ophthalmologist). Dry eye can also be exacerbated by graft vs. host disease, which I have anecdotally seen worsened within radiation fields and is characterized by a lasting m...
Do you offer RT both to the prostate and synchronous oligometastases in de novo oligometastatic prostate cancer?
We do not yet have good evidence to tell us whether or when we should offer metastasis-directed therapy (MDT) for de novo oligometastatic prostate cancer. ORIOLE (like STOMP) was conducted in the recurrent setting. Those trials showed that MDT could delay progression and possibly allow a delay in th...
For those treating osteoarthritis with LDRT, is there any concern of adverse effects or decreased efficacy in patients with osteoporosis?
I’m not aware of any data specifically looking at the efficacy of LDRT for OA in patients with osteoporosis. The anti-inflammatory mechanism of LDRT should not be altered by the bone thickness/quality, but repetitive “injury” contributing to OA may be different if the cause is related to bone qualit...
Do you add ADT to RT for a patient with intermediate-risk prostate cancer with discordant Decipher and ArteraAI results?
This will be a long response to try to provide transparency to these tests from what I know as a researcher and clinician. I also clinically see this situation frequently. We have made incredible progress in developing biomarkers in prostate cancer, but it is important to know that no single test is...
Is it necessary to prescribe a steroid taper after two weeks of high-dose prednisone (60 mg daily)?
Interesting question. Not being an endocrinologist, I don't have the expertise to advise but the reference below makes the statement that even short-term steroids can be an issue. I suspect that if you have to stop abruptly from 60 mg daily for 2 weeks, it would probably be fine in most instances bu...
Would you consider ultra-hypofractionated 5 fraction regional nodal radiation in a node + breast cancer who otherwise wouldn't tolerate 16 fractions of RT?
At this time, unless there was a strong reason that hypofractionated breast + RNI in 15-16 fractions couldn't be done, I wouldn't use 5 fx breast + RNI off-trial. If compelling reasons, one could consider extrapolating safety of breast RT from FAST/FAST-Forward and axilla from melanoma data.
How are you modifying your current sarcoma-directed therapy in the setting of the COVID-19 pandemic?
Here are the guidelines at Fox Chase Cancer Center by Margaret von Mehren MD, @Dr. First Last , Jeffrey Farma MD, Sanjay Reddy MD, John Abraham, MD, and Stephanie Greco, MD I. Management of STS during COVID-19 Pandemic: During the current pandemic, care will need to be changed to allow for hospitals...
Is there any consensus or guidance on how to manage germ cell tumor patients in the COVID-19 era?
Germ Cell Tumor Management in face of SARS-CoV-2: Safe, Rational Modifications to Standard GCT Practice to Protect Public Health, GCT Outcomes, GCT Patients, and Health Systems. This bulletin has been produced by a concerned group of international experts in germ cell tumors, has not undergone exten...
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...