Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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...
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 ...