Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do HIV/AIDS patients with prostate cancer have increased radiation toxicity?
This small study suggest that outcomes are the same for HIV vs. non-HIV patients. That's also been my general experience.Matched cohort analysis of outcomes of definitive radiotherapy for prostate cancer in human immunodeficiency virus-positive patients. (Kahn S, Jani A, Edelman S, Rossi P, Godette ...
What is the difference between involved node and involved site irradiation?
In both involved node and involved site (ISRT), prechemotherapy GTV determines the CTV. However, ISRT accommodates cases in which optimal prechemotherapy imaging is not available to the radiation oncologist. In ISRT, clinical judgment in conjunction with the best available imaging is used to contour...
Is it time to start incorporating involved site irradiation for all lymphomas?
Involved site radiation is becoming the new standard therapy for lymphomas and the goal is to incorporate the ISRT concept broadly. ISRT evolved to update field design guidelines to take into account 3D imaging rather than base field design on bony anatomy which is the way we designed fields in the ...
Does current data support use of intraoperative breast radiotherapy?
I use the intrabeam IORT system and have treated about 90 patients. 22% have been given adjuvant whole breast or breast/axilla/scf xrt. The toxicity of IORT is significantly lower than other forms of APBI and external beam. The results of the Targit A trial support our experience in regards to toxic...
Should I use Oncotype to determine whether to offer adjuvant radiation to women with DCIS?
The conventional risk factors for risk of recurrence are age, size, margin width, and grade.In the multivariate analysis in the Oncotype study, conventional factors of menopausal status (surrogate for age) and tumor size were still significant for risk of recurrence.Grade and margins were not, but i...
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...