Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you find the pCR improvement with neoadjuvant ultra-hypofractionated RT in NeoORB compelling enough to start considering sequencing radiation before surgery in selected breast cancer patients?
Adjuvant radiation remains the standard of care in breast cancer; however, the concept of pre-operative or neoadjuvant radiation (NART) has held durable appeal for both early-stage and locally advanced breast cancer due to several potential advantages. First, it allows for treatment to intact anatom...
Would you offer PMRT to a pre-menopausal patient with early stage breast cancer, favorable biology, and an axillary dissection showing pN1a disease?
The role of PMRT in this situation remains controversial with factors considered including age/menopausal status, number of nodes, presence of ECE, receptor status, neoadjuvant chemo use, etc.If the patient received neoadjuvant therapy and ypN1, I would offer PMRT.If no neoadjuvant therapy, I often ...
Would you offer a male patient adjuvant radiation for treatment of his breast cancer if his axillary dissection specimen shows a single node with isolated tumor cell(s) (ITC)?
If a male patient had a mastectomy with ITCs in a single node, I would not recommend adjuvant radiation.
If a SNB is positive after neoadjuvant chemo and mastectomy, should an axillary dissection be performed or xrt given to all?
Just to clarify, the Alliance 011202 study takes patients with involved axillary nodes before induction chemotherapy who fail to convert to node-negativity post-induction, and randomizes them to axillary dissection vs not. Everyone on the trial gets comprehensive regional RT. There are options for i...
In a patient with ypN+ breast cancer with an adequately dissected axilla, do you omit radiation to the dissected axilla when treating the regional nodes?
I usually omit radiating adequately dissected axilla even in ypN+. Exceptions may include macroscopic ENE (>2mm), extra-nodal infiltration of tumor cells, surgeon's concern about disease clearance (usually matted nodes etc so that's also ENE), large number of nodes positive (I usually consider for N...
Following mastectomy with a SNB and single positive axillary lymph node, would you refer a patient back for an axillary dissection if she has borderline indications for PMRT?
For macromets: If there is no indication for PMRT, then patients are referred back for ALND. That being said, there are patients who decline ALND because of lymphedema and in these patients do perform PMRT with RNI in lieu of ALND . For micromets: No additional axillary intervention and no addition...
Is there any situation where hypofractionation of post-mastectomy radiation (CW and regional nodes) is absolutely contraindicated?
While not absolute given some phase 2 data, I am not currently offering hypofractionated PMRT to patients with reconstruction, as I am awaiting results of the Alliance trial. I do offer hypofractionated PMRT to patients who are not undergoing reconstruction. However, I am cautious in patients with c...
Would you ever consider a nonoperative approach for cutaneous angiosarcoma when a patient achieves a complete or near-complete clinical response after chemoradiotherapy?
Some limited surgery is generally favored, especially if the original site is still present after induction chemotherapy or chemo-RT. Extensive surgery and prolonged healing times are less favored, in particular if they will become barriers to prompt adjuvant RT delivery or systemic therapy delivery...
Would you use adjuvant hypofractionation (15-20 fractions) after BCT with negative margins for a patient with malignant phyllodes tumor?
We conventionally fractionate all our phyllodes patients given there is really no data currently (that I’m aware of) that supports hypofractionating this uncommon disease entity.The Dartmouth-led series studied patients using conventionally fractionated radiation.Barth Jr. et al. PMID 19424757Their ...
How do you prevent radiation induced colitis?
My primary strategy to prevent radiation-induced acute large bowel injury is to try to minimize the dose delivered to the bowel as much as possible. In patients who I think might be at high risk of developing this problem, I will give them written instructions about diet modifications (low fiber, lo...