Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you manage small oropharyngeal cancers with N1 or N2 disease?
For T1-2N1 oropharyngeal cancers there is data from MD Anderson and Toronto that they do quite well with RT alone. These patients are excluded from current RTOG chemo-RT protocols. It is possible that more advanced tumors that are HPV(+) in non- or remote smokers will also do very well with RT alone...
Do you use altered fractionation in patients with locally advanced head and neck cancers who are not candidates for chemotherapy?
yes
Is there a role for PET/CT in pancreatic cancer staging or treatment planning?
PET is not routinely used in pancreatic cancer staging or treatment planning. The current standard of care is a “pancreas protocol” (i.e. three phases of contrast and thin cuts) CT. MRI can also be helpful.
How do you control for organ motion when treating pancreatic cancer?
Typically I use a forced breath hold to essentially eliminate motion so that setup variation is all that we have to deal with after delineating a tumor on CT.
What's the worst advice you received as a young attending?
It was not made clear at the outset or during my early years either expectation or timeline for promotion. I thought being a good doctor, participating in projects, and team meant someting. Grants, # of papers, quality of journals, and local a little, national a lot, and international would be spec...
Do you ever give postoperative chemoradiation in patients who underwent preoperative chemotherapy for gastric adencocarcinoma?
This is not a particularly data-driven approach, as the MAGIC trial did not give post-operative chemoradiation (and most patients did not tolerate the planed post-operative chemotherapy), while INT-0116 did not give pre-operative chemotherapy. We don’t have data demonstrating that combining the two ...
Do you stage and treat GE junction tumors like gastric or esophageal cancer?
The 7th edition of the AJCC staging manual states that GE junction tumors should be staged like esophageal cancer. The “POET†trial showed that for tumors of the distal esophagus, GE junction and cardia, neoadjuvant chemoradiation is superior to neoadjuvant chemotherapy (Stahl et al. JCO 27:851-...
Which regimen is better for gastric adenocarcinoma- neoadjuvant chemotherapy or adjuvant chemoradiation?
There are common criticisms of both the MAGIC and INT-0116 trial results.In the MAGIC trial consisting of preoperative (3 cycles ECF) and postoperative (3 cycles of ECF) vs surgery alone, there was inconsistent preoperative staging.. Lymph node dissections were left to the discretion of the surgeon ...
What criteria do you use to treat the supraclavicular region in women with T1-2 disease breast cancer and 1-3 positive lymph nodes?
When seeing a patient in this situation, I ask myself, "Does this patient seem more like an ACOSOG Z11 patient or an MA.20 patient?" The MA.20 trial, presented at ASCO in 2011, suggested that regional nodal radiation improved distant disease-free survival compared to breast only radiation. While not...
Is irradiation of the supraclavicular and internal mammary lymph nodes now considered the standard of care in women with node positive breast cancer?
I hope that this question can be answered more definitively in the near future. At the present time, I await publication (and untimately more maturity) of the MA-20 data set as well as data from EORTC 22922 trial. I read that 10 year data from the EORTC trial will be presented in Europe at the end o...