Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you counsel your breast-cancer survivors about weight-loss/dietary modifications?
Normal body mass index (BMI) and maintenance of weight is associated with a more favorable outcome (in many series both cancer-related and non-related) compared to higher BMI. Similarly higher level of exercise and metabolic equivalent (MET) is also associated with better outcome in many observation...
What is the risk of secondary malignancy and/or conversion to MPNST for patients with NF-1 who undergo radiation?
Broadly speaking, this is certainly a possibility and this has been a reason why the community has triaged the application of radiotherapy to more high-risk cases (Williams et al., PMID 19117870). Just playing out the numbers independent of the application of radiotherapy, 100% of NF1 patients will ...
How would you treat a patient with cN1 MIBC, treated with neoadjuvant cisplatin-based chemotherapy with outstanding clinical response, who is no longer a cystectomy candidate?
This is certainly a not uncommon clinical scenario in practice with, unfortunately, limited prospective data. The ECOG ACRIN INSPIRE trial (EA8185) is aiming to generate key prospective data in this setting. For patients with node positive patients and great response to initial systemic neoadjuvant ...
What recommendations do you give to patients who ask about diet during breast cancer treatment?
Women with breast cancer are at risk of gaining weight during treatment. It is the perfect storm: Decreased activity and increased appetite from the steroids. Sometimes women think they are going to loose weight so they compensate - so informing patients of the risk is a first step. There are numero...
Do you offer adjuvant treatment for resected colloid pancreatic carcinoma?
I rarely offer adjuvant radiation for typical pancreatic ductal adenocarcinoma except in cases of positive margins, and then only after an adequate duration of chemotherapy has been given. Therefore, I do not think adjuvant radiation therapy should be routine in colloid pancreatic carcinoma, which i...
Would you ever consider chemoradiation for bladder preservation in someone who has had prior LDR prostate brachytherapy?
The board answer is no, he should have a cystoprostatectomy, but that is often not practical. Bladder cancers may arise in men after the brachytherapy either as a result of that treatment or incidentally. The radiation induced cancers appear more than ten years later by which time the men may be in ...
Is there a role for dose escalation beyond 50.4 Gy in neoadjuvant chemoradiation therapy for rectal cancer?
There are probably a variety of opinions about this, but there is no proven role for doses higher than 50.4 Gy. Doses between 50Gy and 60Gy have been studied extensively, including a PhII trial reported by RTOG that was negative for pCR endpoint with 59Gy, and there is no dose response within this r...
How do you approach elective nodal irradiation in muscle-invasive bladder cancer?
The evidence regarding elective nodal irradiation (ENI) in patients undergoing organ preservation with chemotherapy and radiation is mixed, especially when considering data from surgical studies. A meta-analysis involving approximately 17,000 patients indicated that nodal dissection improved outcome...
Is reirradiation in the setting of DCIS of the breast ever appropriate?
If the question means DCIS as IBTR after previous surgery and RT, then would say, would follow the same criteria as IDC for reradiation. Long DFS (at least 2 years but prefer longer) from previous RT, able to get repeat lumpectomy with negative margin with reasonable cosmetic outcome, suitable for P...
How do the results of INSEMA and SOUND impact the decision of omitting SLND in young women with breast cancer and offering adjuvant RT to patients who would otherwise be candidates for omission?
Both trials required radiation so I would recommend it for a young woman not getting sentinel lymph node evaluation, and would lean toward whole breast irradiation. INSEMA required whole breast irradiation and SOUND allowed partial breast irradiation (10% of patients) but the majority of patients re...