Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Should NSCLC with positive cervical nodes be managed with definitive chemoradiation?
The AJCC staging system in conjunction with the IASLC lymph node map is quite clear on this issue. Cervical lymph nodes are non-regional and in the TNM classification are noted as M1b or stage IV. From a practical standpoint though, one should consider the number and location of the lymph nodes in q...
Would you consider post-mastectomy radiation in patient with a triple negative tumor pT2N0?
In borderline cases, I look at some of the retrospective data showing higher recurrence rates in patients with close margins, premenopausal status, higher grade and T2 tumors.In the specific case in the OP, I would discuss the data from the Chinese randomized trial (green journal 2011) showing an OS...
What IGRT strategy do you use when treating intact prostate and lymph nodes?
This does become challenging at times. Most of the time we give a slightly larger PTV margin for nodal CTV and keep similar margins for the Prostate. We align daily to Prostate as it is being treated to higher dose and make sure PTV margin which is given to nodes is sufficient to cover nodal CTV. On...
What are your considerations in choosing partial breast irradiation versus external beam hypofractionated whole breast RT for early stage breast cancer?
Accelerated partial breast irradiation has become a standard of care option for appropriately selected patients. Currently, patients who can be offered APBI come from the ASTRO guidelines or the more recently updated ABS partial breast guidelines released.In general, I will consider APBI for node ne...
How are you approaching head and neck re-irradiation cases if the recurrent cancer has been resected but with high risk features such as ECE etc.?
These are challenging situations with no correct answer.I assume we are talking about squamous cell ca and not other histologies.There is one randomized study from Europe addressing salvage surgery and re-RT vs observation. The study was conducted from 1999-2005 so much of the RT techniques and deli...
Have you ever used sodium alginate to treat radiation-induced mucositis of the upper digestive tract?
Below are randomized results to what may be the referenced study: Yokoyama et al., Annals of Oncology 2019. Here's the punch line: "Sodium alginate did not show a significant preventative effect on radiation-induced severe esophagitis in patients with NSCLC."
How would your management change for high-risk prostate cancer in a patient who is not a surgical candidate (due to age or medical comorbidities) and had prior pelvic irradiation?
Thank you for your question. Indeed, much of the data on re-irradiation in the pelvis corresponds to recurrent disease in GI or GYN malignancies. Historically, many physicians would recommend androgen deprivation alone as management in the setting of high risk prostate cancer with prior pelvic RT. H...
For Hodgkin lymphoma patients with initial splenic involvement, do you ever include the pre-chemotherapy involved spleen as part of your consolidative ISRT treatment after a CR?
Our long standing policy, first at Yale, for the last 3 decades at Duke, has been to use consolidation RT to all sites of disease known to be present prior to chemotherapy, irrespective of "bulk". On a log scale little difference between bulk and clinically detectable disease of any size. The origin...
Would you treat a patient with an early stage favorable breast cancer who has synchronous advanced (or metastatic) NSCLC?
Unfortunately, despite recent advances, the survival for locally advanced or metastatic NSCLC remains poor. As someone who treats both lung and breast, I would have a multi-disciplinary discussion with the teams regarding any added benefit of treating the early stage breast cancer. I think the facto...
Would you offer a patient over 70 years old with early stage, favorable breast cancer adjuvant whole breast radiation if her sentinel node biopsy shows a single node with isolated tumor cell (ITC)?
ITC would not change my decision about AI alone vs. RT plus AI. If you decide to treat, then make some adjustment of the angle to include low lying nodes in the tangential beam but dont chase the nodal region.