RadOnc on the Run

In the newest episode of RadOnc on the Run, host Brandon Mancini, MD, MBA, FACRO, highlighted the key presentations and themes that emerged from the 2026 American Society for Radiation Oncology (ASTRO) Annual Meeting. Across several oral abstracts and sessions, he discussed how new data affirm that precision targeting is increasingly replacing volumetric approaches and that MRI surveillance is challenging prophylactic cranial irradiation, along with other key shifts in the field.According to Mancini, key data and presentations included the following:·      PACE-Ao   Long-term follow-up from the phase 3 PACE-A trial (NCT01584258) showed excellent biochemical control with prostatectomy and stereotactic body radiotherapy (SBRT) in patients with localized prostate cancer.o   The trial strengthens the argument that every patient with localized prostate cancer who is considering prostatectomy deserves a meaningful discussion about modern radiation therapy, particularly SBRT, before making a treatment decision.·      SWOG S1827/MAVERICKo   In a phase 3 trial (NCT04155034) that enrolled patients with limited- and extensive-stage small cell lung cancer, MRI alone was associated with improved cognitive failure-free survival vs MRI plus prophylactic cranial irradiation.o   The results may fundamentally change the conversation for patients who can reliably undergo MRI surveillance, as routine prophylactic irradiation of a brain without visible disease may no longer be necessary.·      Alliance A071801o   The phase 3 Alliance A071801 study (NCT04114981) showed that among patients who underwent resection for large brain metastases, fractionated stereotactic radiosurgery (SRS) yielded superior surgical bed control over standard SRS.o   When treating a patient with a larger postoperative brain metastasis cavity with external beam stereotactic radiation, fractionated SRS should be strongly favored over single-fraction treatment.Mancini is the medical director at Bold Advanced Medical Future Health, a clinical associate professor in the Department of Radiology at Michigan State University College of Human Medicine, and the editor at large for RadOnc Review, a supplement of the journal ONCOLOGY®.References van As N, Patel J, Tree A, et al. Efficacy of radical prostatectomy versus stereotactic body radiotherapy (SBRT) for localised prostate cancer: results from an international phase III randomised controlled trial (PACE-A). Presented at: 2026 ASTRO Annual Meeting; September 26-30, 2026; Boston, MA. Abstract LBA 32. Rusthoven CG, Redman M, Brown PD, et al. SWOG S1827/MAVERICK: a randomized phase III trial of brain MRI surveillance with and without prophylactic cranial irradiation (PCI) for small-cell lung cancer (SCLC). Presented at: 2026 ASTRO Annual Meeting; September 26-30, 2026; Boston, MA. Abstract LBA 03. Aizer AA, Brown PD, Ballman KV, et al. Alliance A071801 phase III trial: Postoperative single fraction SRS vs. fractionated SRS (fSRS) for resected brain metastases: results from the phase III Alliance A071801 randomized trial. Presented at: 2026 ASTRO Annual Meeting; September 26-30, 2026; Boston, MA. Abstract LBA 01.

In observance of World Radiotherapy Awareness Day on September 7th, Rad Onc on the Run host Brandon Mancini, MD, MBA, spoke with Sandra Turner, MBBS, PhD, to spread awareness of this global dedicated platform for radiation oncology. Their conversation touched upon the movement’s origins, strategies for navigating ongoing access disparities across the world, and other ideas for empowering local advocacy efforts for radiotherapy.Turner began by outlining the history of World Radiotherapy Awareness Day, which included the selection of September 7th in honor of the first patient undergoing treatment with a modern linear accelerator in 1953 at Hammersmith Hospital. She also described her role as a co-founder of the movement alongside Katie Wakeham, FRCR, PhD, a clinical oncologist at Imperial College Healthcare NHS Trust. Since the beginning, the movement has gained the support of 88 professional radiotherapy societies across the world, including organizations such as the American Society for Radiation Oncology (ASTRO) and the European Society for Radiotherapy and Oncology (ESTRO).A part of World Radiotherapy Awareness Day’s vision, Turner described, is dedicated to addressing access gaps, even in wealthier countries, due to misconceptions, inadequate referral pathways, and other obstacles. She noted that approximately 1 in 3 patients in Australia have access to radiotherapy when 1 in 2 is expected based on need, while millions in countries such as Nigeria are underserved due to a lack of functional linear accelerators and equipment. Turner detailed how efforts such as World Radiotherapy Awareness Day can help stabilize these access gaps as the global incidence of cancer continues to rise.To engage local oncologic communities, Turner highlighted tactics such as hosting morning tea events at hospitals and educational career nights for students. Additional efforts in the future, she said, will prioritize resources for regional leaders to influence government policy and secure investment decisions based on data-driven advocacy.“I want [the radiation oncology community] to hear and be part of one voice for radiotherapy. We can shift the dial, but we all have to work together. We have either the same or similar problems; we need to talk with the same voice,” Turner concluded. “We need to have simple messages. We need to repeat them again and again, and we need to have confidence and hope that [by] working together, we can make change for the benefit of our patients.”Learn more about World Radiotherapy Awareness Day here. Mancini is the medical director at Bold Advanced Medical Future Health, a clinical associate professor in the Department of Radiology at Michigan State University College of Human Medicine, and the editor at large for RadOnc Review, a supplement of the journal ONCOLOGY®. Turner is a radiation oncologist and clinical professor at the University of Sydney, as well as co-chair of World Radiotherapy Awareness Day.

In a special edition of RadOnc on the Run, Brandon Mancini, MD, hosted a roundtable discussion focusing on the expanding use of radiopharmaceutical (RPT) therapy in cancer care. He was joined by colleagues Mallika Marar, MD, MBA, and Neil K. Taunk, MD, MSCTS. They detailed how RPT is moving into earlier treatment settings, discussed the rapid expansion of the RPT pipeline, and shared practical considerations for integrating RPT modalities into a real-world treatment plan.The conversation began with an overview of how the RPT field has gradually evolved, with Taunk highlighting key agents such as lutetium Lu 177 dotatate (Lutathera), the prostate-specific membrane antigen (PSMA)-targeted lutetium Lu 177 vipivotide tetraxetan (Pluvicto), and I-131 MIBG (Azedra) across different patient populations. Furthermore, Marar noted that personalization of RPT-based care involves optimal patient selection and identifying a proper treatment sequence, with future innovations potentially including the ability to adjust individual regimens through extending cycles or integrating rechallenge strategies.According to Marar, alpha-emitting therapies like actinium-225 PSMA may represent another promising area for those with prostate cancer. Taunk also described the possibility of repurposing existing agents to manage new indications, such as using dotatate-based therapies to treat patients with refractory meningiomas.As part of educating clinicians on the use of RPT and other advanced modalities, Marar emphasized the need to include comprehensive theragnostic experience in standard radiation oncology residency training. Furthermore, Taunk said that trainees should seek out high-volume centers and form connections with nuclear medicine colleagues to learn more about how to leverage novel RPTs.Mancini is the medical director at Bold Advanced Medical Future Health, a clinical associate professor in the Department of Radiology at Michigan State University College of Human Medicine, and the editor at large for RadOnc Review, a supplement of the journal ONCOLOGY®. Marar is a clinical assistant professor of Radiation Oncology - Radiation Therapy, a clinical assistant professor of Radiology - Rad/Nuclear Medicine, and a director of Theragnostics in the Department of Radiation Oncology at Stanford University. Taunk is an associate professor of Radiation Oncology and Radiology, as well as director of Brachytherapy, director of Imaging Sciences, and chief of Breast and Gynecologic Services at the University of Pennsylvania School of Medicine.

In the newest episode of RadOnc on the Run, host Brandon Mancini, MD, MBA, FACRO, spoke with Ron DiGiaimo, MBA, FACHE, about strategies for handling billing, coding, reimbursement, and other financial tasks seen in radiation oncology practice. DiGiaimo offered his advice on critical changes to certain financial and payment processes that practicing radiation oncologists should be aware of.The discussion touched upon concerns surrounding payment rates for Medicaid and Medicare, especially in rural areas. Although he noted that radiation oncology is “doing well,” DiGiaimo expressed his concern that some institutions may lose money or even close due to financial strain. He recommended that physicians negotiate a percentage of a specific year’s rates to help insulate themselves from future cuts. Mancini and DiGiaimo also emphasized greater training and advocacy for radiation oncologists when it comes to understanding billing and revenue cycles, especially early on in a physician’s career. DiGiaimo specifically highlighted the potential benefits wealth managers can provide to radiation oncologists and detailed the importance of engaging in the proposed and final rules by Centers for Medicare & Medicaid Services (CMS).Other topics of conversation included the necessity of creating protocols for different disease diagnoses and appealing denials to avoid future appeals and sustain good reputations among insurance companies. Mancini and DiGiaimo also explored how artificial intelligence (AI) may play a greater role in this space, as AI-based tools may assist with timely adjustments to insurance algorithms while reducing paperwork among clinicians.Mancini is the medical director at Bold Advanced Medical Future Health, a clinical associate professor in the Department of Radiology at Michigan State University College of Human Medicine, and the editor at large for RadOnc Review, a supplement of the journal ONCOLOGY®. DiGiaimo is chairman of Revenue Cycle Coding Strategies (RCCS)/Regents Health Resources/RC Billing, which aims to help doctors and hospitals with coding for outpatient specialties.

In observance of National Cancer Survivors Month in June, RadOnc on the Run host Brandon Mancini, MD, MBA, FACRO, invited Jeff White, director of PR & Strategic Communications at the American Society for Radiation Oncology (ASTRO), to speak about his experiences as a survivor of cancer. From this conversation, both offered provider- and patient-level insights about supporting patients through diagnosis and treatment to eventual recovery and survivorship.White began by detailing his initial diagnosis of HPV-positive tonsil cancer and his subsequent treatment course, which consisted of multiple steps involving surgery, radiation, and chemotherapy. Based on these treatment experiences, White and Mancini emphasized a need for greater patient education, support groups, and other resources to adequately prepare patients for what they may encounter in the clinic without overwhelming them with excessive information. White and Mancini also discussed how each member of a multidisciplinary team can assist patients throughout their treatment schedules, touching upon roles such as managing pain between chemotherapy or radiation dosing. Additionally, the discussion addressed how to mitigate lingering symptoms and complications that extend beyond a patient’s treatment, such as anxiety surrounding follow-up scans and assessments.When considering how cancer treatment has evolved over the last several years, White and Mancini’s conversation shed light on how providers could offer hope to patients and survivors alike.“Cancer is a traumatizing word, and there’s just no way to get around that. But [when] connecting with physicians to find out what options are available—there are multiple paths that you can go down depending on your quality of life needs or where you are—I don’t consider it a death sentence,” White stated. “Survivorship has taught me that…[although] I always had an appreciation for my life, I did take it for granted. Focusing on the things that I truly care about [became] a priority in a way that it wasn’t before.”