Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What hypofractionated regimens would you consider for postoperative SCC of the hand with a positive margin?
I have started to use 50 Gy in 20 fractions in all patients with a recent retrospective analysis from Australia for cutaneous squamous and basal cell cancers that has been used for head and neck patients, another sun-exposed site with cosmetic concerns. This type of question is hard to answer as man...
Do you still routinely offer post-op radiation after bone fixation?
This information would not change my practice pattern. I would be interested to know the delineation of the target volume and if all hardware was targeted, as I do not see any radiation details on dose selection/target delineation/etc. Of note, in this series, the median time to initiation of PORT w...
How would you approach adding ADT to salvage radiation therapy for a biochemically recurrent prostate cancer patient with very high Decipher but non-luminal B on PAM50?
Yes, especially if PSA is more than 0.5 ng/mL.
How do you approach the discussion of omission vs. inclusion of adjuvant radiation in patients with low to intermediate-grade DCIS?
There are several factors when evaluating patients with low/intermediate grade DCIS and the role of RT: Estrogen negative. While rare, I almost always recommend RT. Willingness to take endocrine therapy. More and more patients are concerned about taking endocrine therapy and I discuss RT in these pa...
How are you using ArteraAI in 2026 for intermediate risk patients?
Personally, I have not used ArteraAI to guide treatment decisions. None of the advanced prognostic tools of this nature have been prospectively evaluated. Consequently, I am reluctant to use them to influence treatment decisions at this time. The post hoc meta-analyses are promising, and hopefully, ...
When do you start steroids for radiation pneumonitis?
Great question on a relevant clinical topic. It's very important to remember that pneumonitis is a diagnosis of exclusion. Sometimes, if the timing is right and the patient's presentation is typical, there is a tendency to move quickly to the conclusion that the symptoms are caused by pneumonitis. R...
If a patient has a history of lumpectomy and adjuvant radiation, and then develops an in-breast recurrence s/p mastectomy with breast only disease and no nodal disease, would you re-irradiate the chest wall?
Typically not. Now, if the breast lesion is very large or has a positive margin, or was stuck to the muscle, I would consider re-RT. In the adjuvant setting, PMRT is beneficial, but the therapeutic ratio is not that large. Remember some of the older studies (and studies w/o chemotherapy) did not dem...
Would you give PMRT to a young woman with a T1-2 breast cancer with a micromet on SLNB?
No great data as far as I know. In general, I treat micromets as ~pN0. @Dr. First Last and colleagues reported on LRR rates and prognostic factors for failure in pN0 patients treated with mastectomy to identify subsets of node-negative patients with sufficiently high risk of LRR who might benefit fr...
How would you manage a small posterior vaginal defect noted at the time of cervical brachytherapy?
If it is from a disease, I would continue brachy as planned and address the defect based on response and healing. If unrelated to disease, I would have it sutured and continue brachy as planned.
What strategies do you find helpful in advanced care planning with patients/families who are very "miracle" centered?
Hope for the miracle yourself! Broaden: “Are there any other things you are hoping for?” Hope for the best, prepare for the worst: “I see how much you want a miracle. I wonder if we can talk about what we should do if this doesn’t happen.” Consider involving a religious leader if relevant.