Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Has SBRT shown to improve OS or PFS in patients with localized pancreatic cancer who are not a eligible for surgery due to other comorbidities?
I have been giving definitive doses for LAPc for the past 10 years using CT-on-rails at MDACC and now CBCT since moving to Memorial Sloan-Kettering 1.5 years ago. I have probably only been giving the ablative doses listed above for the past 6 years. The initial criteria essentially were that I looke...
What is the role of up-front neck dissection in locally advanced head and neck squamous cell carcinoma?
The place of neck dissection (whether performed before or after definitive chemoradiotherapy) in the treatment of advanced head and neck cancer continues to be debated, with wide institutional variability in practice. Prior to this recent randomized trial from the UK published in the NEJM (N Engl J ...
Are there any circumstances in which you would treat only the lymph nodes and omit the chest wall for PMRT?
At present I have not done regional RT alone without chest wall in patients needing PMRT. There is a report from Europe where for patents who have had sentinel node positive, radiation has been delivered to regional node in liu of axillary node dissection without chest wall RT especially when primar...
For breast cancer with occult primary, do you favor radiation therapy or mastectomy for local management?
The incidence of occult primary in the breast has gone down significantly in the era of MRI imaging. That being said, in this uncommon situation where MRI imaging is negative, we favor RT to the breast along with regional nodes and the literature shows low IBTR in these patients.
After cryoablation for early breast cancer are there any particular considerations to take when planning adjuvant RT?
I presume cryoablation has been performed rather then standard lumpectomy. I have no personal experience with this approach. The concerns are that the usual information (ie margins status) is lost. Further, the questioner has supplied no additional information of sentinel node status, pt age, recept...
What is the most appropriate radiation dose and volume for elderly and/or frail patients with advanced SCC of the anal canal not receiving chemotherapy to attain durable local control?
Even for very debilitated cases, I have pushed the medical oncologists to give at least one cycle of 5FU (1gm/(m2-dy) X 4 Days) concurrently with RT. For these cases I have reduced the treatment volume if possible and have been more inclined to give a treatment break. HIV positivity alone would not ...
Do you omit adjuvant radiotherapy in T4a laryngeal SCC with favorable prognostic factors?
I guess one could omit PORT for such a situation. I have never encountered this situation and I don't know what data NCCN is using to support this recommendation. Historically, pT4 is the indication for PORT.
What options would you present to an otherwise healthy patient with early-stage breast cancer who absolutely refuses surgery?
The best option is to start the patient on systemic treatment (anti estrogen if ER positive) and hope she changes her mind as time passes as there is not much data on any of the options listed and local control would not be optimal. There is old European data that patients who have a complete clinic...
For a recurrent grade 1 meningioma after resection, do you favor SRS or fractionated RT?
I generally prefer SRS, unless the recurrence is not seen as a discrete lesion, or is in a location in which I would be overly concerned about toxicity with SRS, or toxicity if the cavity needed to be treated with conventionally fractionated radiation in the future. Perhaps if the recurrence develop...
How do you counsel women with a history of breast cancer who have dense breasts, with regards to mammography screening?
The question of how best to follow women after treatment for breast cancer is one that is of great concern to oncologists. Many factors play into the type and frequency of screening. However, little definitive data exists showing benefit of anything above annual screening with mammography. For our s...