Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
When treating patients with hypofractionated radiation to the breast in 16 fractions do you typically treat 4 or 5 days a week?
We treat 5 days a week which was the standard in the Whelan randomized trial that compared this fractionation scheme to conventional fractionation (https://www.ncbi.nlm.nih.gov/pubmed/20147717). In the START B trial, 15 fractions (total dose 40 Gy) were given also in 5 consecutive days (https://www....
Would you offer prostate radiotherapy to a patient with lymphocytic colitis which is being managed with budesonide?
In general, I look for reasons to avoid irradiating the colorectum in patients with chronic inflammatory conditions affecting this organ. These are patients for whom I generally recommend surgery for prostate cancer. If they end up needing adjuvant or salvage radiation, the dose and volume of irradi...
What radiation dose is appropriate for patients receiving induction chemoradiation prior to surgery for superior sulcus tumors?
RTOG 0229 demonstrated the safety and efficacy of increasing the radiation dose to 61.2 Gy in the trimodality setting. Therefore, current standard concurrent chemoradiation therapy uses 61.2 Gy, which is safe with or without surgical resection, with improved mediastinal nodal clearance rate (63%). 4...
Do you electively cover the celiac axis in a patient with node negative middle third to distal, and GEJ esophageal carcinoma?
We do treat celiac axis nodes for distal esophagus and GE junction tumors along with the gastrohepatic nodal region for patients treated with a curative intent.
Would you offer salvage RT to a patient with adverse features after prostatectomy if his post-operative PSA was highly elevated (for example >10 ng/mL), but his metastatic work-up was negative?
The benefit in a patient like this with salvage RT is very limited if at all and I would not offer RT. This persistent elevation of more than 10 after surgery is from occut metastatic disease and local RT would not help with the outcome. Ga68 PSMA PET if available may pick up some of the disease tha...
What is the role of radiation in a patient with limited stage small cell lung cancer initially treated with chemotherapy alone and received a complete response based on CT and PET-CT?
From the 1990's SCLC studies of Ralph Johnson at the Radiation Oncology Branch, and then a later NCI re-analysis of that 100 patoient data set, the pattern of concurrent for 3-4 weeks was better than a longer period of time, or a shorter period of time including sequencing for many cycles followed ...
Is there evidence to limit a patient's intake of antioxidants such as vitamin C during radiation to prevent detrimental outcomes?
Many cancer patients take mega-doses of antioxidants in the hope of reducing treatment related side effects, improving the odds of cure and/or preventing second primary cancer. Unfortunately, high quality trials addressing these issues are lacking and available data are largely limited to pre-clinic...
What criteria do you use to guide your decision on adjuvant radiation for thymic carcinoma?
We use NSCLC regimen to treat thymic carcinoma, either preop chemoRT or adjuvant chemoRT for advanced disease, positive margins, etc..
Should pre-pectoral implants be avoided for reconstruction in breast cancer patients out of concern that it may mask local recurrences?
None of outcome data has shown that having reconstruction with impant or autologous flap has increased or delayed the diagnosis of local recurrence. Some of it could be explained based on site of recurrence which is usually superficial to pec muscle. The publication by us outlines sites of local rel...
What is your approach for, and in which situations would you use, an external boost in the management of gynecologic cancers?
The most important and consistent indication for external boosts is in the treatment of regional disease. In nearly all cases where there is evidence or suspicions of gross nodal involvement, we treat the sites of gross disease to at least 60 Gy, while areas of microscopic disease typically receive ...