Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
Do you omit adjuvant radiotherapy in T4a laryngeal SCC with favorable prognostic factors?
I guess one could omit PORT for such a situation. I have never encountered this situation and I don't know what data NCCN is using to support this recommendation. Historically, pT4 is the indication for PORT.
What options would you present to an otherwise healthy patient with early-stage breast cancer who absolutely refuses surgery?
The best option is to start the patient on systemic treatment (anti estrogen if ER positive) and hope she changes her mind as time passes as there is not much data on any of the options listed and local control would not be optimal. There is old European data that patients who have a complete clinic...
For a recurrent grade 1 meningioma after resection, do you favor SRS or fractionated RT?
I generally prefer SRS, unless the recurrence is not seen as a discrete lesion, or is in a location in which I would be overly concerned about toxicity with SRS, or toxicity if the cavity needed to be treated with conventionally fractionated radiation in the future. Perhaps if the recurrence develop...
How do you counsel women with a history of breast cancer who have dense breasts, with regards to mammography screening?
The question of how best to follow women after treatment for breast cancer is one that is of great concern to oncologists. Many factors play into the type and frequency of screening. However, little definitive data exists showing benefit of anything above annual screening with mammography. For our s...
In what situations do you consider radiation to the pelvic and inguinal lymph nodes without treatment of the primary in vulvar cancer?
Good data in vulvar carcinoma is rare as there are not very many patients and not very many studies. Having said that, there is some data available.Among the literature is a 1994 Red Journal Article by Duesenberry et al. This is a study of 27 vulvar patients of which 13 patients had recurrences in t...
How do you address the risks of radiation-induced carcinogenesis when counseling younger adult patients (40-60 years old) on definitive radiation therapy for non-melanomatous skin cancer of the head/neck?
This question has been debated for many years both in the literature as well as in definitive textbooks. No good answer has ever been fully proven. The risk of carcinogenesis is relatively low, estimated to be one in 1000 patients treated. Non-melanoma skin cancer is easily treated and cured by radi...
What do you recommend for patients who experience anorexia due to loss of appetite?
"But to eat when you are sick, is to feed your sickness."- Hippocrates A lot of preclinical work (Valter longo, Warburg etc) show he was probably right and the fact that tumors will preferentially have access to gluocse and proteins (ie PET scan-Warburg effect)I would use steroids (dexamethasone or ...
For an unknown primary manifested in a left supraclavicular node, what area would you treat with radiation therapy?
Is it adenocarcinoma or squamous cell carcinoma as suspected primary could be in head and neck region or abdominothoracic region in practice I have treated once for squammous cell cancer and opted to treat ipsilateral involved site only with adjoining level 4 and 5 region.
Does finding a positive surgical margin containing pleomorphic LCIS in a patient with early-stage invasive ductal carcinoma of the breast affect your management in regards to breast conservation therapy?
Based on limited data, we treat PLCIS with the same principal as DCIS and aim for a negative margin and offer adjuvant RT. PLCIS presents with microcalcs like DCIS and in the pre e-cadherin staining era, they were called DCIS and included in the old NSABP study as DCIS.
What dose is required to gross disease in the definitive treatment of vulvar cancer?
As with all gynecologic carcinomas, the optimal dose is at least to some extent dependent on the volume of disease. However, our experience suggests that a minimum of 60 Gy should always be given for gross diasease, even when concurrent chemotherapy is being given. That said, for gross disease that ...