Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What is the role of surgery in patients with Stage III NSCLC and N2 positive lymph nodes?
Interestingly: Patients that were to get lobectomy has survival of 2.8 years with surgery and 1.8 years with CRT However, for pneumonectomy patients, patients treated with surgery had survival of 1.6 years while those treated with CRT had a survival of 2.4 years. So.. patients with disease that see...
For a patient treated with Mohs surgery for a high risk skin cancer of the head/neck do you post-operatively treat all scars to full dose, including those created at subsequent closure?
There are a few high quality studies of adjuvant radiotherapy to the site of a primary skin cancer that help guide the answer to your question that I am aware of. Based on first principles, it would seem like the area that the tumor originated, as well as the surrounding area at risk for subclinical...
How common is hypothyroidism in postradiation head and neck cancer patients?
The incidence of postradiation hypothyroidism is hard to determine, as the literature is quite varied. This variation is due to a combination of how hypothyroidism is measured, how much of the thyroid was treated, and when patients were assessed. Recent literature suggests the incidence can approxim...
Is there any role for SRS+WBRT for patients with a limited number of small brain metastases?
The recent publication from Dr Brown confirmed the finding from prior studies, that omitting upfront whole brain RT doesn't compromise OS in patients with limited brain metastases. More importantly, this second study had neurocognition as the primary end point, and confirmed better neurocognition pr...
Has SBRT shown to improve OS or PFS in patients with localized pancreatic cancer who are not a eligible for surgery due to other comorbidities?
I have been giving definitive doses for LAPc for the past 10 years using CT-on-rails at MDACC and now CBCT since moving to Memorial Sloan-Kettering 1.5 years ago. I have probably only been giving the ablative doses listed above for the past 6 years. The initial criteria essentially were that I looke...
What is the role of up-front neck dissection in locally advanced head and neck squamous cell carcinoma?
The place of neck dissection (whether performed before or after definitive chemoradiotherapy) in the treatment of advanced head and neck cancer continues to be debated, with wide institutional variability in practice. Prior to this recent randomized trial from the UK published in the NEJM (N Engl J ...
Are there any circumstances in which you would treat only the lymph nodes and omit the chest wall for PMRT?
At present I have not done regional RT alone without chest wall in patients needing PMRT. There is a report from Europe where for patents who have had sentinel node positive, radiation has been delivered to regional node in liu of axillary node dissection without chest wall RT especially when primar...
For breast cancer with occult primary, do you favor radiation therapy or mastectomy for local management?
The incidence of occult primary in the breast has gone down significantly in the era of MRI imaging. That being said, in this uncommon situation where MRI imaging is negative, we favor RT to the breast along with regional nodes and the literature shows low IBTR in these patients.
After cryoablation for early breast cancer are there any particular considerations to take when planning adjuvant RT?
I presume cryoablation has been performed rather then standard lumpectomy. I have no personal experience with this approach. The concerns are that the usual information (ie margins status) is lost. Further, the questioner has supplied no additional information of sentinel node status, pt age, recept...
What is the most appropriate radiation dose and volume for elderly and/or frail patients with advanced SCC of the anal canal not receiving chemotherapy to attain durable local control?
Even for very debilitated cases, I have pushed the medical oncologists to give at least one cycle of 5FU (1gm/(m2-dy) X 4 Days) concurrently with RT. For these cases I have reduced the treatment volume if possible and have been more inclined to give a treatment break. HIV positivity alone would not ...