Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Is there a role for prophylactic cranial irradiation in non-lung neuroendocrine carcinoma?
I think series with other sites are too small for any meaningful conclusion. The limited literature for small cell cervical cancer has not shown a high incidence of isolated brain metastases, but rather it has shown that it is usually part of metastases to other sites with lung being one of them. Fo...
What are your preferred dose/fractionation options for treatment of hemoptysis related to central lung metastasis?
50 Gy in 5 fractions every other day with SBRT.
When should SBRT be preferred in operative patients who cannot undergo a lobectomy?
Numerous retrospective studies have examined clinical outcomes between SBRT and surgery using a variety of different statistical tests- propensity analyses, matched-pair comparisons, multivariable analyses, and so forth. Collectively, these studies report conflicting results. No randomized data with...
For patients with brain tumors without a history of seizure, what is your policy on driving?
There is no standard in the United States.We have no written policy. However, if there is clear neurocognitive impairment or there are clinical findings that can impair one's driving ability, I report to the state with a form from the Driver License Bureau that is filled out and then the DMV perform...
Do you recommend adjuvant chemoradiation for T2N0 gastric adenocarcinoma?
In general, we do not recommend adjuvant RT for T2N0 gastric adenocarcinomas unless other adverse factors were present. The long term results of the INT-0116 trial stated patients were T3-4 or node positive, but the initial report says stages IB-IV. Notably, the studied allowed T1N1 but not T2N0. Al...
Given the MA20 results, do you consider CW plus SCV or even regional nodal radiation postmastectomy for pT3N0 with high risk features?
I would certainly recommend PMRT for T3N0 with high-risk features (LVI, grade III, etc.). Actually, even before the MA 20 data is available, T3N) with LVI has a higher risk for LF as demonstrated in one of our papers (Floyd et al ). To avoid PMRT for T3N0, there should be no high-risk features (no g...
What is the role of neoadjuvant chemotherapy in the treatment of locoregionally advanced nasopharyngeal carcinoma?
I think the data on neoadjuvant chemotherapy continues to show a lack of survival benefit in this disease. I think HN001 is the preferred treatment as we give the definitive treatment, which is radiation therapy, followed by asking the question of what to do in the adjuvant setting.
Do the results of the GEPAR trials indicate that PMRT based on pre-neoadjuvant chemo risk factors, irrelevant of pCR, should be the standard of care until NSABP B-51 is completed?
I do not think the GEPAR ASCO 2015 abstract and presentation should be used to conclude that we should recommend PMRT for all node + positive patients regardless of response to preoperative treatment.There are several reasons for this:*This is an unplanned analysis of the studies, in which radiation...
Do you counsel young patients on infertility risks following HO prophylaxis with RT?
Yes, we do counsel. We also use scrotal 'clamp-shell' blocking. We also block the ovaries. We advise, as we do for other patients who receive RT close to genital areas, that they should avoid child bearing for 6-12 months.
When is postoperative radiation appropriate for a typical lung carcinoid tumor?
Postoperative radiotherapy in usually NOT indicated for a typical thoracic carcinoid tumor which are obviously considered low-grade neuroendocrine tumors as opposed to atypical carcinoid which are intermediate grade. The risk of nodal metastases for a typical carcinoid is low, on the order of < 5-1...