Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Can I treat breast nodal volumes with hypofractionation?
Yes. Published randomized trials have treated/reported 2,000 patients with doses of >2 Gy in hypofractionation vs standard fractionation trials with treatment to the axilla. Trials include Start A/B (513 patients), the old trial by Ragaz et al., PMID 15657341 (318 patients, hypox 37.5 Gy in 15 fx), ...
What is the maximum dose that you would give to residual unresectable gross disease in the axilla in the setting of recurrent breast cancer s/p ALND?
The FAST-Forward boost trial will be informative here, and I would recommend reading the protocol, because one can consider using the standard arm now, which is 40 Gy to the breast (and nodes, when RNI is indicated), and a 48 Gy boost, all in 15 fractions. This dose is recognizable as the breast boo...
How do molecular and clinical factors guide personalized selection of HSRT dose fractionation regimens with bevacizumab in recurrent high-grade gliomas?
Multivariate analysis identifying HSRT dose fractionation, tumor grade, IDH mutation, and 1p/19q codeletion as significant predictors of progression-free survival (PFS) in recurrent high-grade glioma strongly supports a shift toward biomarker-driven stratification in future trials. These findings un...
What dose and fractionation do you use in the setting of head and neck reirradiation?
We have traditionally treated recurrent HNC with full standard fractionated RT concurrent with chemo. In recent years we have transitioned to SBRT, typically 40 Gy in 5 fractions. The use of SBRT is more convenient; current data suggest that both methods achieve similar tumor control rates and simil...
What RT dose/fractionation would you use to treat an unresectable grade 3 solitary fibrous tumor abutting the optic nerve and chiasm?
Generally, I would consider treating an unresectable grade 3 solitary fibrous tumor to up to 59.4/60 Gy, or possibly higher. The location of this tumor makes it difficult to treat entirely using this dose while respecting the optic nerve/chiasm constraints. How is the patient's vision? If intact, op...
How do you approach management of a patient with intermediate risk prostate cancer treated upfront with HIFU and intermittent ADT who is later found to have rising PSA and biopsy-proven prostate-confined recurrence?
These are frustrating situations, and ones I am now seeing frequently as focal therapies have gained traction in the United States. The approach, needless to say, is highly individualized. Often, these glands are quite abnormal in MRI appearance, and there is a concern for fibrosis. My approach is h...
How do you manage radiotherapy for a glioblastoma when there is a delay in starting systemic therapy?
It depends on whether we are discussing a post op vs unresectable patient.It is okay to delay in post op imo up to 4-6 weeks out after a GTR. I would not start within 2 weeks after biopsy, regardless of temodar authorization in an unresectable patient.Blumenthal et al., PMID 19114694
What are your top takeaways in Radiation Oncology from SABCS 2025?
Several significant studies were presented at San Antonio this year. I will focus on the three most important abstracts reporting new data from studies of local-regional therapy. (The 10-year update of the BIG 3-07-TROG 07.01 trial comparing hypofractionated and conventional fractionation and the us...
What are your top takeaways from ASCO GI 2026?
GLP1 agonist use is associated with improved outcomes for colorectal cancer in a retrospective United States study. Now we need to incorporate this into randomized trials. I think this also provides more evidence that metabolic syndrome type issues may help explain early-onset colorectal cancers. W...
How have you incorporated ctDNA into the clinical management of patients with gynecologic cancers?
ctDNA certainly is increasing rapidly in oncology and has been led by several other disease sites. I think right now, GYN oncology is figuring out how to incorporate this in our care to meaningfully impact our patients. I have not incorporated ctDNA in my practice routinely, but do see the role of i...