Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you advise patients to avoid deodorant during breast radiotherapy?
This I believe is oncolore, and it has been around for decades. When I was a resident, I was taught to specifically counsel breast patients not to use deodorant because it could increase skin toxicity, either due to the physical surface coating or due to the metals in most deodorants. There are 4 ra...
Do you recommend treating the chest-tube site or pleural biopsy tract in patients receiving RT for malignant pleural mesothelioma?
I'm not sure that there is yet a definitive answer to this question.in the UK we used to use 21Gy in 3# with electrons to the chest wall sites -anecdotally I don't recall anyone coming back at that time with local recurrence but many may not have lived long enough back then for us to see it.It might...
Would you recommend definitive local treatment of locally recurrent breast cancer with a positive contralateral axillary lymph node and no signs of distant metastasis?
Locally recurrent breast cancers are known to have aberrant nodal spread, including the contralateral axilla, because of previous axillary dissection and radiation. We treat these patients as locoregional disease with a combination of locoregional and systemic treatment. You do take previous treatme...
For which patients with localized prostate cancer is SBRT an alternate standard of care?
The ASTRO Policy says it best: ASTRO Policy Statement on SBRT for Prostate Cancer Many clinical studies supporting the efficacy and safety of SBRT in the treatment of prostate cancer have been published. At least one study has shown excellent five year biochemical control rates with very low rates o...
In which patients with early-stage favorable Hodgkin's lymphoma, if any, would you consider omitting consolidation RT after ABVD chemotherapy?
The GHSG HD16 randomized trial was recently reported at ASH (Abstract 925). Patients with early-stage, favorable HL (per GHSG criteria) were randomized to standard treatment (ABVD X 2 followed by 20 Gy of RT) or a PET-directed approach. If PET negative after 2 cycles (defined as Deauville 1-2), then...
Do you recommend breast MRI for patients with invasive lobular breast cancer considering breast conservation therapy?
I agree with @Dr. First Last. I used to get MRIs in women with lobular cancers routinely, but as data have shown no outcome benefit to pre-op MRI and a higher mastectomy rate associated with the use of MRI, I now only get MRIs in patients in whom the surgeon feels that the other imaging is too equiv...
Do you ever consider treating the axilla in patients with multiple nodes with ITCs?
ITC is treated like node negative and we do not address either by surgery or radiation for these early stage breast cancer treated by mastectomy.
What is the standard RT dose in locally advanced NSCLC with concurrent chemotherapy?
I have an opinion on this topic....several opinions actually! The paper is coming out soon. We included a tremendous amount of data. I hope you will read through it in your journal clubs. I agree with @Dr. First Last that the results of RTOG 0617 were a 'kick in the gut'. They were (and are) certain...
In Stage I-II primary mediastinal B-cell lymphoma (PMBL), bulky or non-bulky, is post-chemotherapy radiotherapy still standard in patients with a complete response to CHOP-R chemotherapy?
Primary mediastinal B-cell lymphoma (PMBCL) is a rare subtype of DLBCL. It is a clinicopathologic entity by WHO criteria (which makes it occasionally difficult to conclusively diagnose). The typical patient is young, female, with a large, anterior mediastinal mass. The optimal therapy for PMBCL is c...
What's it like to be a radiation oncologist at a Veterans Affairs hospital?
Leland, a collegue here at Richmond, said it well. I’m inspired each day. While cancer can be scary, many Veterans have faced death before. Our patients have an incredibly high level of resilience and trust in the system. Many are dual beneficiaries, with both VA and Medicare benefits, but prefer to...