Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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...
How would you treat node positive (pN+) prostate cancer with undetectable post-op PSA after radical prostatectomy and pelvic LND?
The short answer is, YES I would, in general, recommend treatment. I also respectfully disagree that ADT monotherapy is the standard of care. It is an option of course, but rarely performed given it is non-curative and the data to support its use is of minimal relevance today.Some key points of reas...
How do you approach rising PSA following radical prostatectomy and early salvage radiation therapy?
There are several factors that I will take into consideration, including the patient's overall health, the interval from treatment to relapse, the PSA doubling time (rather than a PSA threshold), whether or not they're castrate resistant and whether or not they now have overt metastatic disease. Pat...
What is the best treatment for a medically inoperable endometrial adenocarcinoma of the uterus FIGO 1, grade 1, type 1?
I would get a pelvic MRI to assess tumor size and myometrial involvement. If small volume (2 cm or smaller) with superficial invasion then use brachy alone, otherwise EBRT plus brachy. The type of brachy is based on uterine width: If the width is less than 5 cm: single tandem and cylinder. Otherwise...
How do you approach adjuvant therapy for resected lung adenocarcinoma that was found unexpectedly postop to be N2?
Preliminary results of the phase 3 randomized LungART trial (NCT00410683) were recently presented at a virtual ESMO conference. 501 patients with pathologically confirmed N2 NSCLC s/p complete resection were randomized to postoperative RT (54 Gy) or observation. Almost all patients received chemothe...
What are your top takeaways in Medical Oncology from SABCS 2025?
lidERA trial. This is the first phase III trial showing an advantage for an oral SERD giredestrant over standard endocrine adjuvant therapy in early breast cancer. Treatment with giredestrant led to a 30% reduction in the risk of invasive disease recurrence over standard endocrine therapy at the fir...
What are your top takeaways in Breast Cancer from ESMO 2025?
ASCENT-03: At ASCO, the results of ASCENT-04 already showed an improvement of PFS (11.2 months vs. 7.8 months) in first-line setting for PD-L1 positive advanced triple negative breast cancer patients treated with sacituzumab plus pembrolizumab compared to chemotherapy plus pembrolizumab. The ASCE...
Will you extrapolate EORTC 1333/PEACE-3 (enzalutamide + Rad223) to any other ARPIs for mCRPC?
PEACE-3 was a cooperative group study of radium-223 plus enzalutamide versus enzalutamide alone in men with mCRPC. There was a significant improvement in OS (38 months vs 32 months). Most patients in the trial were previously treated with ADT monotherapy instead of intensified therapy (i.e., ADT + A...
How do you manage significant gas in patients undergoing pelvic radiotherapy?
This is tough, especially once the simulation is completed, the patient comes in for treatments and now you see very different anatomy. The one thing that I have changed in practice - and I'm aware this is not always possible at higher volume centers - is to have the simulation at about the same tim...
Would you offer upfront radiation for a large painful keloid of the chest that has arisen from an irritated pyoderma gangrenosum lesion?
Radiation therapy is actually used (rarely) for pyoderma gangrenosum that has been unresponsive to medical management via immunosuppression [1]. Single fraction doses of 400 to 800 cGy have been used with slow regression of the lesions. In the case report cited, the lesion started fading after 3 mon...