Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What duration of androgen deprivation therapy do you use for patients with pN+ prostate cancer undergoing upfront adjuvant RT after a radical prostatectomy and pelvic lymph node dissection?
As @Dr. First Last mentioned, the Messing randomized trial (ECOG 3886) showed that lifelong ADT (vs. observation) improved overall survival in patients with pN+ prostate cancer after radical prostatectomy. This trial provides the only level 1 evidence for this patient population. Therefore, ADT shou...
In what situations do you treat the elective neck for patients with resected esthesioneuroblastomas?
Our experience (Demiroz C et al., IJROBP 2011) includes 26 patients with ENB, all of whom had N0 neck at diagnosis, and none had received neck RT (about half received primary site adjuvant RT). The results were: 26% neck recurrences: 6/19 in Kadish B and 1/5 in Kadish C. Most recurrences were in lev...
What is the best management of early stage breast cancer in patients with a minimal life expectancy (<10yrs)?
I believe in individualized, whole patient care. Life expectancy is incredibly difficult to estimate, but if we are somehow certain a patient will live less than 10 years, then quality (rather than quantity) of life likely becomes the primary concern of a patient with early stage breast cancer. We d...
What is the best treatment management of low grade early stage follicular lymphoma of the mesentery?
If a patient has a single mesenteric mass or lymph node that is demonstrated to be low-grade follicular lymphoma after biopsy, and there is no evidence of disease elsewhere by PET-CT or bone marrow biopsy, then definitive RT (24-30 Gy) would be appropriate. Mesenteric lymph nodes can be more challen...
What adverse pathological features would be an indication for WBI (whole breast irradiation) after a patient receives IORT for early breast cancer?
Outside of the core TARGIT-A protocol, there are no other official protocol-defined pathological features warranting adjuvant EBRT. The protocol however allowed for centers to add other path risk factors justifying EBRT ie extensive LVSI +/- G3 +/- SMS .2-1cm +/- +SnLN.Mitigating risk of recurrence ...
How would you manage a patient with stage I pure seminoma diagnosed incidentally after transscrotal orchiectomy?
For me, I would want to know the T stage and some other specifics about the case. The only option that I would not consider would be radiation therapy due to potential disruption of the usual dissemination paths. Surveillance with abdominal/pelvic CT scans would still be expected to catch relapse ea...
Is it appropriate to treat a Stage IE DLBCL of the cervix with close followup if a CR is achieved after 4 cycles of R-CHOP followed by a hysterectomy omitting RT?
The role of involved site radiotherapy after effective chemotherapy is to treat sites of previously known disease, not to address unknown regions of micrometastatic disease. If the gross disease was confined to the cervix and/or uterus, a hysterectomy is an acceptable substitute for consolidative ra...
Is it necessary to cover the drain sites during post-mastectomy radiation?
I have not been chasing/treating the drain site for PMRT unless it is in a conventional chest wall field. The recurrence data does not suggest that the drain site at risk after PMRT. Below is review of site of relapse after mastectomyhttps://www.ncbi.nlm.nih.gov/pubmed/26383675
What scans do you order for follow-up in locally advanced non-small cell lung cancer patients who have completed definitive radiation with concurrent chemotherapy?
To my knowledge, there are no randomized studies that have examined the role and frequency of surveillance imaging in locally advanced NSCLC treated with chemoradiation. There is an ongoing randomized study looking at two follow up schedules in completely resected NSCLC (PMID 17519819).NCCN recommen...
Is ATM a contraindication to radiation therapy?
The data is limited with some concern about increased late efffects including fibrosis and increased risk of contralateral breast cancer caused by RT. I have not used this as absolute contraindication but discussed pros and cons with few patients I have treated and taken all measures to reduce contr...