Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How was treatment response assessed on the PROSPECT trial?
Dr. Harvey reached out to his colleague, Dr. Marc Gollub, director of radiology at Memorial Sloan Kettering with expertise in gastrointestinal imaging (and who was the radiologist who collaborated on PROSPECT), for his thoughts on this question. Here is his answer: I had to “create” a non-volum...
While we await the completion of RTOG 1008, what instances do you offer chemotherapy for salivary gland tumors?
There are no current prospective data about adding chemotherapy to definitive or adjuvant RT for high-grade salivary gland tumors. Data from the National Cancer data base suggested no improvement of post-op CRT compared with RT (Amini A et al, Jama Otolaryngol-HN Surg 2016), however there were more ...
How would you approach adjuvant treatment in a patient with completely resected undifferentiated pleomorphic sarcoma of the chest wall that recurred after 2 years, initially treated with neoadjuvant radiation and resection?
There is no evidence to support adjuvant treatment after re-resection. In the case of recurrence, we prefer to biopsy the mass to prove recurrence and obtain tissue (for NGS). In the case of recurrence, if we were to give systemic therapy, then we would favor neoadjuvant chemotherapy- provided this ...
What is the role of EBRT/brachytherapy (as an addition to chemotherapy) in the adjuvant management of optimally debulked stage IV uterine serous carcinoma?
There is no prospective study in this setting and based on limited retrospective data we do consider adjuvant RT for optimally debulked (meaning no macroscopic disease left behind after surgery) disease. We do consider pre surgery bulk of disease in decision making and would recommend RT for those w...
Can radiation therapy alone for localized recurrence of high-grade B-cell lymphoma be considered for those that previously received rituximab-based chemotherapy?
High-grade B-cell lymphomas are distinct entities no longer classified as "diffuse large B-cell lymphoma" by the WHO. They include: High-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements (often referred to as double hit or triple hit lymphoma). High-grade B-cell lymphoma, NOS (thes...
How does prior prostate artery embolization impact your treatment recommendations for prostate cancer?
PAE is a "newer" modality that is being used to treat LUTS in men with BPH and BPH symptoms at baseline. Case series report relatively impressive results, with the average AUA score dropping from around 20 to 8 in populations receiving this therapy. PAE is sold as a procedure that is unlikely to hav...
How do you respond to a patient who asks "Why do I still need breast radiation after chemotherapy if chemotherapy treats the whole body?"
Perhaps one of the best arguments supporting RT in breast cancer is the not-that-often cited Scottish Trial that randomized women to postoperative RT or chemotherapy following breast conservation; the breast failure rate following adjuvant chemotherapy alone approximated 30% with short follow-up. Ob...
What adjuvant treatment would you offer a patient who underwent cystoprostatectomy for a muscle invasive bladder cancer and discovered to also have prostate cancer?
Complex case. If they have an indication for prostate RT (major: positive LN, persistent PSA, +SVI, minor: + margins, +ECE), I would consider treating the prostate fossa +/- LNs. As far as the bladder, we don't have the answer yet, but high-risk patients are being studied on the BART study from Tata...
What methods do you use to prophylactically reduce radiation dermatitis for head and neck irradiation?
My approach has been: Start Remedy (less greasy but less effective) and/or Aquaphor (more greasy but more effective) 3-4x daily at beginning of RT. Try to use Aquaphor at least at night when the greasiness is less bothersome. If patients have some other alcohol-free/non-anti-oxidant product they re...
Would you offer local radiotherapy to prostate in a patient with small cell neuroendocrine carcinoma who had a complete response to chemotherapy?
Thank you for this great question. Yes, I would strongly consider radiation therapy to the prostate and pelvic LNs for small cell carcinoma of the prostate. Small cell carcinomas of the prostate are rare and comprise <1% of all prostate cancers and are known to be more aggressive. They are often unr...