Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is there a role for consolidation radiation in a patient with stage I low grade follicular lymphoma treated with chemotherapy?
First, while there is no "standard" treatment for stage I follicular lymphoma due to a scarcity of randomized studies, most North American and European guidelines indicate that the "preferred" treatment is radiation therapy. This is based on several single institution series demonstrating that radia...
For patients with stage 1A-E extra nodal marginal zone lymphoma that has been completely excised, would you still consider radiation?
Not if it has been excised completely
Should one perform a sentinel node biopsy in a clinically negative axilla prior to neoadjuvant chemotherapy?
For an upfront clinically and radiologically negative axilla, where the SNLN is negative for disease after chemo, we don't change our RT field. For an upfront clinically and radiologically negative or positive axilla where SNLN is positive even after chemo, then normally they undergo full dissection...
Is weekly Cisplatin considered a valid alternative to Cisplatin cycles every 3 weeks as part of definitive chemo-radiation for muscle invasive bladder cancer?
None of the RTOG trials had this approach, but extrapolating from head and neck cancer (cisplatin 30mg/m2) or cervical cancer (40mg/m2), people in the community are using weekly cisplatin. As far as data, there is a phase II study from Australia utilizing cisplatin 35mg/m2 weekly for 6-7 cycles show...
Is there a role for post-operative chemoradiation therapy in fully resected, margin-negative T3N1 NSCLC?
I assume you're talking about T3 for chest wall invasion, and I think the answer is probably no routine role for RT for this individual risk factor. If you look at surgical series, invasion of the chest wall IS a risk factor for both positive surgical margins, and local recurrence. But if you limit ...
For breast cancer patients requiring staging, should one order a CT C/A/P & bone scan or PET scan?
For locally advanced disease (T4 or N2), I would favor PET/CT because of the higher yield for identifying metastatic disease. It is also important for the radiation oncologist because of the higher likelihood of identifying of involved IM nodes and level 3a and supraclavicular nodes which can change...
When would you use concurrent cetuximab with radiation for a patient with H&N cancer who is not a good candidate for concurrent chemotherapy?
Additional data has been added since I have addressed this question in 2015: the role of concurrent cet-RT in HNC patients who cannot receive chemotherapy. The large majority of these patients are elderly with heavy smoking/drinking history, and typically have non-HPV related Sqcca associated with p...
Should the incorporation of thoracic RT be standard in patients with extensive stage small cell lung cancer?
The jury is really still out on the issue of whether or not to add thoracic radiation therapy to prophylactic cranial irradiation (PCI) in patients with extensive-stage small cell lung cancer. The published data cited above, Slotman et al. in Lancet last Fall 2014, indicate that there may be an over...
Would you treat a patient with small cell lung cancer (limited to lung and mediastinum) but also with a malignant pleural effusion with upfront definitive thoracic chemoradiation?
I would treat such a case as EXTENSIVE DISEASE. That means chemotherapy with 4 cycles of Plat/Etop, and restage with PET. If the pleural disease has gone by imaging or/and pleural tap, I would add thoracic radiotherapy 30 gy/10 fractions and PCI 2.5 gy X ten. If the pleural space remains positive, I...
Can chemotherapy be used instead of radiation therapy in a patient with extensive stage small cell lung cancer who presents with epidural spinal cord compression?
I think it would have to be done on a case-by-case basis, and the answer is likely "Not a good idea." Chemo can make SCLC shrink a lot, but you'd really have to monitor day by day with CAT scans. And it unlikely to take the pressure off the spinal cord arteries within hours to days, as is needed. Th...