Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How do you take tumor seeding into account when staging NSCLC?
This is a rare situation but based on the current AJCC staging, if this is in same lobe then would stage as T3 disease. If discovered after treatment of the primary disease, we would still treat this like a localized process, as is not hematogenous spread and not like metastatic disease. Seeding of ...
Would you offer PMRT for an axillary-only recurrence after a remote mastectomy and ALND in a patient with early stage breast cancer?
Yes. This patient's relatively early recurrence in the axilla is an indicator of either suboptimal initial surgery, aggressive biology, or both. Following axillary dissection, chemotherapy may be warranted and a discussion with the medical oncologist is certainly appropriate. Following chemotherapy,...
Do you treat the contralateral RP nodes up to the base of skull in a node-negative neck if the primary tumor involves any hypopharyngeal subsite?
An older Red Journal article (Chao et al., 2002) provides some recommendations on RP coverage on the basis of recurrence data/ nodal involvement at presentation as stratified by subsite. The tables in this paper have many strata, however briefly according to the data compiled in this paper of the pa...
What specific dietary changes do you recommend for patients undergoing H&N, CNS, or GI RT?
I would leave Boost and Ensure as the absolute last recommendation possible. This goes for Carnation Instant breakfast as well, which is mostly made up of sugar and high fructose corn syrup. These supplements are poor sources of nutrition for anyone, let alone cancer patients. As cachexia is a state...
What is your preferred treatment choice for GBM that crosses the corpus callosum?
We never push for aggressive surgery in this case. The surgeons will not resect disease from the corpus callosum (due to resulting neurological issues), so further attempt of surgery would delay therapy in a group of patients that tend to do poorly, despite favorable prognostic factors.
Do you make any distinction or have any special consideration when considering a patient for hypofractionation for left versus right breast cancer?
In general I see no major issue with hypofractionation and cardiac issues. Whether standard or hypofractionation the cardiac dose should be minimized to the greatest extent possible by any combination of techniques including deep breath holding, cardiac blocks, etc. Keeping the mean heart dose as lo...
Is it possible to palliate presacral recurrences of rectal cancer in patients who previously received neoadjuvant chemoradiation to the rectum?
Our institution has reported on a small series of presacral recurrences in previously treated patients with SBRT with good response and palliation.http://www.ncbi.nlm.nih.gov/pubmed/22269400
In post-op RT for head and neck cancer with a close or positive margin, is there data suggesting that 66 Gy at 2 Gy per fraction provides better local control than 63 Gy at 1.8 Gy per fraction?
I do not think there is any good data to support this. Historically, 2 randomized trials come to mind. The first is the MDA Peters et al trial, that looked at varying doses with 1.8 gy fractions, and concluded that 63Gy was the optimal dose for higher risk patients. The second study was published by...
Would you treat the inguinal nodes in a patient who had an adenocarcinoma excised from the anal canal?
I would definitely include the external iliac nodes for such a case. I would also definitely add the inguinal nodes if the cancer were extending to the verge or beyond. I would also scrutinize the imaging studies very carefully; a 1-2 cm inguinal node has to be of greater concern in this setting tha...
Are there situations where you would use hypofractionated radiotherapy for Stage III breast cancer?
The answer to this question is complex, and cannot be adequately explained in a brief response.Treatment of local advanced breast with hypofractionated radiation is not currently an accepted standard practice in this country. This situation occurs in both breast conservation and mastectomy (+/- reco...