Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Does micropapillary subtype for a G1-2 DCIS affect your radiation treatment recommendations?
It doesn’t change the recommendation. If adequate, imaging and surgery are done, like any other DCIS.
Do you use liver SBRT to areas previously treated with Y90 and subsequently failed?
Prior Y90 is a risk factor for liver decompensation that's hard to quantify. If there is relatively low volume disease and I am retreating with complete overlap of the prior TARE, I don't think there isn't any increased risk with retreatment. If the TARE went to more than 1-2 segments, I would be co...
Does the presence of perineural invasion on a prostate biopsy change your management decision?
I would consider perineural invasion as one of the "soft" criteria that may help impact treatment decisions. Previously this would have also included such things as Gleason 3+4 vs. 4+3, Gleason 8 vs. 9-10, or the percentage of positive cores. However, as these factors have now been included in the A...
Should regional nodes be included in whole breast RT for a favorable pT3N0 breast cancer after lumpectomy and SLNB?
I do not typically recommend RNI in a T3N0 following breast conserving surgery with negative SLN. While patient factors such as young age and pathologic factors ER-/Triple negative, LVSI concern me, they are not enough for me to offer RNI in a node negative patient.
How do you choose between neoadjuvant and adjuvant chemo-immunotherapy for patients with resectable stage II-IIIA NSCLC?
The billion dollar question. For patients with resectable stage II-IIIA NSCLC, how do you choose between neoadjuvant and adjuvant chemo-immunotherapy in light of the recent FDA approval of the CheckMate-816 regimen? Of course, this approval quickly followed in the footsteps of the FDA approval of at...
What is your preferred comprehensive nodal irradiation approach in non-metastatic breast cancer patients with underlying respiratory diseases or poor baseline respiratory function in light of the findings from the RadComp Trial?
The RadComp trial PRO-CTCAE item for no shortness of breath versus any shortness of breath significantly favored protons as reported in the abstract. However, after correction for multiplicity, this became non-significant, meaning there was no difference. While multiplicity analyses ensure that fals...
What are your top takeaways from ASCO GU 2025?
In terms of practice-informing presentations in prostate cancer here are my top 3: GROUQ-PCS 9 trial (Canada, abstract 22). This trial led by Niazi et al tested whether metastasis-directed radiotherapy based on conventional imaging to up to 5 sites provided benefits in delaying rPFS or PSA progressi...
How do you approach post-lumpectomy surveillance in male breast cancer patients without BRCA or other mutations?
Annual mammograms, with additional sonogram if needed.
For a patient receiving postmastectomy IMRT to chest wall with expander and regional nodes including IMN, what constraint would you use for dose to the contralateral chest wall/implant if the patient also had a mastectomy and reconstruction on that side?
I use similar numbers and tend to accept a more generous approach to achieve coverage if the patient has undergone a contralateral mastectomy vs intact breast.
Would you consider radiation alone or chemoradiation therapy for a small vulvar cancer near the urethra or clitoris?
Yes, I think radiation is worth considering in this situation. However, the morbidity of radiation is also significant with potential for edema and fibrosis in high dose volume. The consequence of that may arguably be worse than surgery. If we do treat with radiation, I would still add chemotherapy ...