Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
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 ...
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 ...