Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Would you recommend adjuvant radiotherapy with concurrent Ado-trastuzumab emtansine (T-DM1) in your breast cancer patients?
In the Katherine trial (von Minckwitz et al. NEJM 2018) 1486 patients with non-metastatic invasive residual HER2+ breast cancer after preoperative chemotherapy were randomized to 14 cycles of trastuzumab or trastuzumab emtasine (T-DM1), an antibody-drug conjugate of trastuzumab and the cytotoxic age...
How do you approach rectal spacer for the patient with renal failure?
Have not come across this but I would presume it would be filtered with dialysis in pts with renal failure.
How are you integrating IMRT into whole brain radiation for brain metastases?
Whole brain radiation therapy with IMRT for hippocampal avoidance with memantine should be considered the standard of care for patients not eligible for SRS.
Do you refer patients to cardiology if they have no history of cardiac disease but will be receiving XRT with high mean doses to the heart?
Great question! Yes, we are starting to refer patients to cardiology who have Stage III NSCLC or LS-SCLC and are receiving high-dose radiation therapy. Trying to tease out whether its heart dose or central tumor location, or some combination of the two, that confers a poorer prognosis is challenging...
How do you decide treatment volumes for radiotherapy for bilateral gynecomastia secondary to bicalutamide therapy?
I recall treating more of these cases in prostate cancer patients in the earlier period of my career when DES and flutamide was used more often. And I don't recall having to re-treat anyone. We did both therapeutic and prophylactic RT -> with the latter we/some use 8-10Gy x1(http://www.nice.org.uk/c...
In a patient with Waldenstrom's macroglobulinemia doing well and feeling better on ibrutinib & rituximab, but with a rising IgM, do you switch treatment or continue?
A lot depends on the pace of increase of the IgM and the line of therapy. If the pace is rapid, I would think about changing therapy. If the pace of increase is small and the patient is asymptomatic, you could continue a little longer. If planning to changing therapy, it may be reasonable to restage...
When considering post mastectomy radiation, do your recommendations change for a biopsy proven positive intramammary node in the axillary tail (prior to neoadjuvant chemotherapy) vs. positive axillary node?
Data on intramammary nodal disease suggest that it has worse outcome than node negative disease and these pts at increased risk of axillary involvement I do take that as one of adverse factors in deciding PMRT after NACT in these pts but if they have BCT done then don't change target in itself based...
How would you treat a patient with locally and distant recurrent rectal cancer who has previously received chemoradiation but now presents with pain and bleeding from the site of local recurrence?
Generally we like to see a 1 year interval between courses of radiation. We give 39Gy in 26 fx BID with a 3D conformal technique. The cumulative BED should be <100 or so. We use a 3 cm margin cranial an caudal on the GTV and include the presacral space. We give concurrent capecitabine.
When using concurrent hyperthermia with reirradiation, is there any benefit to delivering hyperthermia on non-RT days?
Hyperthermia alone, in the absence of radiation or chemotherapy, is not effective as cancer therapy, not withstanding occasional reports to the contrary from sources of questionable reliability. Hyperthermia is a very effective sensitizer for both RT and chemo. Note that we are not. discussing high ...
How does breast cancer histology affect your decision whether to omit radiation?
More than histology grade ( grade 3) influences whether to omit RT or not .