Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How would you treat an unresectable SCC of the skin local recurrence in the base of skull with clinical and radiographic CN involvement?
I usually target gross disease to at least 70 Gy in 35 fractions if my treatment intent is curative. I try to avoid fractional doses >2 Gy around optic nerves and chiasm, so would not typically use 55 Gy in 20 fractions for this reason. HyPERfractionaton, proton beam and concurrent systemic therapy ...
Would you recommend lung cancer screening in someone who is not a surgical candidate?
This is our commentary on this topic: http://www.ncbi.nlm.nih.gov/pubmed/26226384
In a patient with ER+/HER2- breast cancer, do you ever use Oncotype testing to assist in decision-making regarding adjuvant chemotherapy when the tumor size is less than 0.5 cm, or when there are positive lymph nodes?
The NSABP and other data that was approved for prognostication and for prediction of benefit with chemo excluded 5 mm or smaller tumors. In practice, oncologists would not offer chemo for ER positive and node negative tumors that are 5 mm or less in size . Thus, I would not do oncotype do testing. B...
In women with cN0 breast cancer who receive neoadjuvant chemotherapy due to other high-risk features, how does the finding of treatment effect in a post-chemo sentinel lymph node affect your radiation recommendations?
The answer is not known and I am sure practice pattern varies. Our decision to treat regional nodes is usually based on the number of sentinel nodes dissected (the negative predictive value of residual disease in the axilla is a function of the number of nodes and the use of dual tracer in clinicall...
Do you ever use bevacizumab in combination with standard radiation and temozolomide in the first-line setting for patients with glioblastoma?
Two clinical trials (AVAGLIO and RTOG 0825) used bevacizumab (Avastin) along with standard temozolomide and radiation therapy for newly diagnosed glioblastoma. While they did not see improved OS, they did see improved PFS. In an evaluation of AVAGLIO, for those patients who did not go on to receive ...
When would you offer PMRT to a patient after prior TNI for lymphoma?
It would depend on total dose. If the dose in the past was in the 30s, in these patients I have usually been reluctant to treat the supraclavicular area again to decrease risk of plexopathy. I have treated the chest wall with extra precaution to decrease the dose to the heart (larger conformal block...
How do you manage excessive or difficult to control secretions in patients who have received chemoradiation for head and neck cancer?
Excessive secretions are a problem that many of our patients face but it is important to sort out what "excessive secretions" means. If it is excessive drooling due to dysphagia, then agents such as scopolamine or glycopyrrolate can be helpful. If the problem is excessive phlegm as a reaction to rad...
After chemotherapy for early and locally advanced breast cancer, how long do you advise women to wait before attempting to conceive?
This is an area with little data to guide recommendtions. Population databases have NOT found an increased risk of recurrence in patients who conceive after diagnosis and treatment - if anything those who conceive do better (this form of bias has been called the healthy mother effect). Timing of con...
Do you preform elective nodal irradiation in patients with locally advanced NSCLC who are not candidates for or refuse chemotherapy?
No. Usually if they are not candidates for chemotherapy, there are reasons for it, such as medical comorbidities, that would make you want to limit your radiation fields as well. I would consider treating to a higher dose such as 66 Gy, without systemic therapy.
How do you approach the nodal treatment of vaginal cancer using IMRT or more specifically in what situations do you modify elective nodal coverage?
The nodal target volume should reflect the distribution of disease in vagina and paravaginal tissues. All vaginal cancers generally require treatment of at least the internal and external iliac nodes. For apical cancers, the presacral nodes may be included. Cancers that involve the distal vagina (ne...