Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How are you approaching head and neck re-irradiation cases if the recurrent cancer has been resected but with high risk features such as ECE etc.?
These are challenging situations with no correct answer.I assume we are talking about squamous cell ca and not other histologies.There is one randomized study from Europe addressing salvage surgery and re-RT vs observation. The study was conducted from 1999-2005 so much of the RT techniques and deli...
Have you ever used sodium alginate to treat radiation-induced mucositis of the upper digestive tract?
Below are randomized results to what may be the referenced study: Yokoyama et al., Annals of Oncology 2019. Here's the punch line: "Sodium alginate did not show a significant preventative effect on radiation-induced severe esophagitis in patients with NSCLC."
How would your management change for high-risk prostate cancer in a patient who is not a surgical candidate (due to age or medical comorbidities) and had prior pelvic irradiation?
Thank you for your question. Indeed, much of the data on re-irradiation in the pelvis corresponds to recurrent disease in GI or GYN malignancies. Historically, many physicians would recommend androgen deprivation alone as management in the setting of high risk prostate cancer with prior pelvic RT. H...
For Hodgkin lymphoma patients with initial splenic involvement, do you ever include the pre-chemotherapy involved spleen as part of your consolidative ISRT treatment after a CR?
Our long standing policy, first at Yale, for the last 3 decades at Duke, has been to use consolidation RT to all sites of disease known to be present prior to chemotherapy, irrespective of "bulk". On a log scale little difference between bulk and clinically detectable disease of any size. The origin...
Would you treat a patient with an early stage favorable breast cancer who has synchronous advanced (or metastatic) NSCLC?
Unfortunately, despite recent advances, the survival for locally advanced or metastatic NSCLC remains poor. As someone who treats both lung and breast, I would have a multi-disciplinary discussion with the teams regarding any added benefit of treating the early stage breast cancer. I think the facto...
Would you offer a patient over 70 years old with early stage, favorable breast cancer adjuvant whole breast radiation if her sentinel node biopsy shows a single node with isolated tumor cell (ITC)?
ITC would not change my decision about AI alone vs. RT plus AI. If you decide to treat, then make some adjustment of the angle to include low lying nodes in the tangential beam but dont chase the nodal region.
How would you approach isolated inguinal lymph node squamous cell carcinoma of occult primary?
Most of these are probably anal cancers, just based on the incidence and anatomy. One could certainly argue this either way (local only vs comprehensive). It is tempting to treat local only fields knowing that the salvage rate is probably high, but what has kept me from doing that is that comprehens...
Would you recommend partial breast irradiation using LDR seeds after lumpectomy for a suitable candidate with early stage breast cancer?
LDR is an appropriate consideration for patients eligible for partial breast irradiation; it's important to recognize that LDR was included on RTOG 9517 and more modern series have also evaluated new LDR techniques.There is limited data comparing HDR and LDR, and this would also be dependent on HDR ...
How would you manage a patient with low risk prostate cancer on active surveillance who develops high risk features but absolutely refuses a repeat biopsy?
In the setting of a suspicious mpMRI lesion, we start by acknowledging the patient's likely negative experience with their transrectal biopsy. We ask if they are referring to the one where they were rolled on their side, had a probe inserted in their rectum, and heard a bunch of loud CLICKs. We empa...
How would you manage a cN0 penile cancer with a moderate risk of nodal metastasis?
Pathologic nodal stage is such a strong prognostic factor that patients with moderate or high risk of nodal involvement, even if cN0, should have surgical nodal staging. This includes those patients with MD and PD tumours, and T1b or higher. PET-CT cannot show microscopic involvement. If the patien...