Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
After pelvic irradiation, how often do you recommend that female patients use a vaginal dilator and for how long?
The need for a vaginal dilator is dependent on the degree of stenosis, and related to the total dose, dose per fraction for HDR brachy patients, and patients underlying tendency to form scar tissue. In general we suggest evaluation by the physician every 3 months. If it appears that scar tissue con...
Is there any data to support radiation and targeted agents (Braf inhibitor or ipilimumab) combined for stage III melanoma?
Prospective trials will be reported this year at ASCO on the role of adjuvant ipilimumab (an immunotherapeutic, not a targeted therapy) for melanoma. Prospective trials of adjuvant BRAF inhibitors (vemurafenib, and others) for melanoma are ongoing (not yet reported). At present (4/25/14), there is n...
Do you ever treat the contralateral neck for high grade mucoepidermoid salivary gland carcinomas?
I wont say never, but in general even in the scenario you describe I would say no. This is relatively controversial, and we once did an informal poll among a few HN XRT experts, and in this non-scientific poll a consensus was not reached on the subject.
How can I be a good mentor?
Being a good mentor is possible when the mentor places the mentee's needs first and responds to them in a manner that they would wish to be responded to when they were in a similar mindset and situation. Love is the basis for this encounter. Patience is necessary because it takes time for the truth ...
In a low volume prostate cancer (2 of 12 cores, low percentage) with a GS 4+4=8, how long does ADT need to be administered?
The role of ADT for high-risk disease continues to evolve, with new data emerging annually. While guidelines typically recommend 2-3 years for any high-risk patient, not all have the same risk of failure and/or benefit from ADT. Initial phase III studies from the RTOG & EORTC that showed OS benefits...
Should nodal fields be added to post-mastectomy radiation treatment after neo-adjuvant chemotherapy if there is a CR in the nodes?
There is no good study for this clinical situation. NSABP is conducting a trial where pts who have pCR in clinically positive nodes are being randomised to regional RT vs. no regional RT. In practice, I usually treat for patients with pretreatment clinical N2 disease or have inflammatory breast canc...
Can you observe low grade follicular lymphoma if the involved node(s) have been surgically removed?
There are certainly circumstances where observation for limited stage, low grade follicular lymphoma is warranted. I would not rely on surgical resection alone for cure however. Occasionally surgery can be curative in Stage I extranodal MALT lymphoma.
What is the best treatment dose and fractionation for WBRT in a patient who has numerous brain mets and previously received PCI with 25Gy/10fx for small cell lung cancer?
Based on re-irradiation series for whole brain available in literature (Value of whole brain re-irradiation for brain metastases--single centre experience. , Re-irradiation in the treatment of patients with cerebral metastases of solid tumors: retrospective analysis. ), reasonable palliation (improv...
How often do you order follow up mammograms after breast radiotherapy?
We do it once a year, as doing them more frequently than that has not been shown to improve outcomes and this is endorsed by national societies. There is a recent paper which showed higher yields with 6 month mammograms but this has not shown to improve outcomes and our approach at present is a year...
Is it acceptable to treat glioblastoma with upfront SRS instead of fractionated external beam RT?
There is good prospective randomised data in this setting for using hypofractionated RT alone (34/10 fractions or 40/15 fractions) or Temodar alone (if MGMT methylated). If the goal is palliation and QOL improvement, either of the two based on the clinical situation is a viable option.There is no go...