Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the role of neoadjuvant chemotherapy in the treatment of locoregionally advanced nasopharyngeal carcinoma?
I think the data on neoadjuvant chemotherapy continues to show a lack of survival benefit in this disease. I think HN001 is the preferred treatment as we give the definitive treatment, which is radiation therapy, followed by asking the question of what to do in the adjuvant setting.
Do the results of the GEPAR trials indicate that PMRT based on pre-neoadjuvant chemo risk factors, irrelevant of pCR, should be the standard of care until NSABP B-51 is completed?
I do not think the GEPAR ASCO 2015 abstract and presentation should be used to conclude that we should recommend PMRT for all node + positive patients regardless of response to preoperative treatment.There are several reasons for this:*This is an unplanned analysis of the studies, in which radiation...
Do you counsel young patients on infertility risks following HO prophylaxis with RT?
Yes, we do counsel. We also use scrotal 'clamp-shell' blocking. We also block the ovaries. We advise, as we do for other patients who receive RT close to genital areas, that they should avoid child bearing for 6-12 months.
When is postoperative radiation appropriate for a typical lung carcinoid tumor?
Postoperative radiotherapy in usually NOT indicated for a typical thoracic carcinoid tumor which are obviously considered low-grade neuroendocrine tumors as opposed to atypical carcinoid which are intermediate grade. The risk of nodal metastases for a typical carcinoid is low, on the order of < 5-1...
What is an appropriate dose for nodular lymphocyte predominant, stage 1 Hodgkin lymphoma following nodal excision?
We would treat to 30 Gy and treat somewhat more than involved site, as patients receive RT alone. This means treating more like involved region which, in this case, would probably be the ipsilateral groin nodal region.See the attached recent update from German group:http://jco.ascopubs.org/content/e...
How frequently should you order brain imaging after whole brain RT in patients not undergoing a planned SRS boost?
MRI every 3-m is recommended by NCCN and adopted by most insurance companies. However, more frequent imaging, such as every 2-m may be considered for melanoma, SCLC, RCC, or patients with large brain metastasis (> 2 cm), due to increased risk of progression after WBRT. Of course, MRI showed be done ...
Is systemic sclerosis an absolute contraindication for breast conserving therapy?
I see systemic sclerosis as a relative contraindication to breast conserving therapy/whole breast radiotherapy. There are a number of case series looking at whole breast radiotherapy in women with collagen vascular disease (CVD). While some of these showed statistically significant increase in sever...
What dose is most appropriate when treating a post-prostatectomy patient with positive margins in the adjuvant setting?
The data for dose response in post RP radiation is not as robust as it is in the definitive setting. All randomised trials for adjuvant treatment used mainly 60 Gy, although retrospective data in the adjuvant setting shows better outcome with dose range from 61.5 Gy to 70 Gy. Similarly in the salvag...
At what point would Radium-223 dicholoride treatment be the best management for a patient with established metastatic prostate cancer with an elevated PSA and symptomatic bone pain with corresponding bone lesions on imaging?
At present, based on the randomised trial, it is approved for castrate resistant prostate cancer (can be chemo naive) with symptomatic bone only disease. In that situation, it improves all skeletal related events and survival and should be an indication to talk about this treatment. However, in prac...
Do you routinely include IMNs for left sided inflammatory breast cancer?
In our practice we radiate the IM in all PMRT. The recent studies that mildly favor regional nodal XRT including IM nodes in intermediate breast cancer make it hard to argue to do less in the most advanced. Reviewing studies of PET/CT in IBC provide a rough estimate of gross IM involvement in IBC of...