No matter what kind of treatment a cancer patient receives, the fight against cancer is more than a physical challenge. It impacts everything from emotional well-being to financial stability. I believe that caring for a patient is caring for a person. We at The Farber Center realize that people exist within a matrix of family, friends, jobs, homes, neighborhoods, geographical areas, and psychological and cultural environments, all of which can influence health and disease. Our mission is to develop a treatment plan that is right for our patient and their loved ones in an environment that supports and nurtures them.
I founded the Farber Center for Radiation Oncology with the goal of providing unparalleled, innovative care while catering to patients real lives both at the center and beyond. The first and only freestanding radiation facility of its kind in Manhattan, the Farber Center represents a warm alternative to the sterile and often daunting hospital environment without compromising quality of medical care and they accept most insurance plans. Drawing on my longstanding experience as one of the most respected radiation oncologist in the field, I handpicked the most innovative technology, sought-after physicians, and superior facilities in the world to establish what is first and foremost a superlative treatment center. In fact, The Farber Center's independent status allows the facility to take advantage of the most sophisticated technology available, offering superior treatment under the guidance of highly regarded professionals while treating patients as people.
Oncology - Radiation
NY, NJ, CT, PA
Mount Sinai School of Medicine
American Board of Radiology
Areas of expertise:
Breast Cancer, Partial Breast Irradiation (APBI), Non- invasive APBI, GU, Lung, GYN, Prostate
New York Downtown Hospital
The Farber Center for Radiation Oncology
21 West Broadway
New York, NY
A Board Certified physician in Radiation Oncology, Dr. Leonard Farber has been in private practice for over a decade, recently serving as Chairman of Radiation Oncology at Staten Island University Hospital. Dr. Farber specializes in adult radiation oncology, with particular focus on breast cancer, prostate cancer and gastrointestinal malignancies, lymphomas, head and neck cancers and lung cancers. He is an expert in HDR brachytherapy for various types of cancers, including breast, skin and gynecologic malignancies, and intracranial and body radiosurgery.
After receiving his B.S. and B.A. at the State University of New York at Binghamton, Dr. Farber pursued his M.D. at the Mt. Sinai School of Medicine in New York. Following an internship in internal medicine at Beth Israel Medical Center in New York, he did his residency in Radiation Oncology at the Hospital of the University of Pennsylvania in Philadelphia, where he served as Chief Resident. Dr. Farber is a member of the American Society for Therapeutic Radiology and Oncology, the American College of Radiation Oncology, the American Radium Society, the American Brachytherapy Society, the New York Cancer Society, the New York Metropolitan Breast Cancer Group, the New York Head & Neck Society, and the Long Island Oncology Network.
Treatment options are dependent on a variety of factors including the stage, a patient's other medical conditions, and a patient's understanding of these options. For example, there are now certain conditions/situations where by stereotactic body radiation therapy (SBRT) may be an alternative to surgery. Our physicians always take their time in going through all modalities and side effects with our patients so that they can make the most educated decision for themselves, and be comfortable with the treatment they decided on.
There are particular indications for using radiation therapy in the treatment in melanoma and broken down into three categories: primary disease, regional disease, and metastatic disease. For primary disease, radiation may be considered as adjuvant treatment (following surgery) for patients with desmoplastic type melanoma with extensive neurotrophism- findings determined by a pathologist examining the specimen under a microscope. For regional disease the following are indications after surgery: extracapsular extension, the involvement of 4 or more lymph nodes (two or more lymph nodes if cervical lymph nodes involved, size of the primary tumor >3 cm, and recurrent disease after prior complete lymph node dissection. Finally, for metastatic disease radiation therapy may be used to treat brain metastases alone or after surgical resection, and other symptomatic or impending symptomatic involvement of bony metastases or soft tissue resection. For more information please see The National Comprehensive Cancer Network (NCCN) Guidelines. Margins are determined by a pathologist reviewing the surgical specimen and measuring the distance from where tumor is seen to the nearest point of normal tissue.
Stereotactic radiosurgery is a type of external beam radiation therapy utilizes very precise and multiple beams in a small number of treatment fractions (one to five), and with a high dose delivered per treatment fraction. Often times radiosurgery is a terminology people refer to for a single fraction and stereotactic radiosurgery when it is more than one fraction- up to five, but the terms are relatively interchangeable. There is no surgery or cutting involved, as the treatment is non-invasive. Radiosurgery can be used to treat lesions in the brain, such as brain metastases, for spine metastases, and in the body for primary lung tumors, lung metastases, other organ metastases, and now to the prostate as primary treatment. Because of the ablative response of the tumor to this type of treatment it is now also known as stereotactic ablative radiotherapy, or SABR.
Brachytherapy for the treatment of melanoma is used for the treatment of choroidal or uveal (intraocular) melanoma as an eye-sparing technique. It is also referred to as plaque brachytherapy and can be performed with several isotopes including Iodine 125 (125I), gold 198 (198Au), palladium 103 (103Pd), and others. Guidelines are available by the American Brachytherapy Society:http://www.eyephysics.com/PS/PS5/UserGuide/References/PDF/Red_J_Articles/AmerBrachyRec03.pdf
Radiation therapy is used in the palliative settings for nearly all types of cancers. For example, it can be used to treat pain related to bone metastases from different primary sites, improve respiratory symptoms from a tumor blocking airways, improve swallowing conditions related to esophageal tumors. Radiation therapy can also be used in the prophylactic palliative setting for brain metastases, lesions in vertebral bodies before they cause pain or neurological symptoms, or impending bone fractures. For the majority of times a tumor causes symptoms there is often a role for radiation to address and improve them palliatively.
Radiation therapy treatment schedules and the doses delivered per treatment vary depending on the intent to treat (definitive or curative intent versus palliative intent), the tumor type (breast, prostate, lung, etc), a patient's overall condition, and the accessibility of patient to receive radiation treatment. Furthermore, centers with more state-of-the-art equipment can offer different treatment options because of the capability of the technology. There are treatment guidelines within the radiation community, as well. We encourage patients to do their homework, know that often times there are multiple treatment options available (even if the first place they go to doesn't have them), and to even call some of our patients who have completed treatment for other opinions.
Acute side effects from radiation typically last anywhere from 3-6 weeks following completion of radiation therapy. Depending on the extent of the skin-related side effects, which may be related to a person's individual anatomy, side effects may persist on the longer side of this time scale.
I am sorry to hear about your experience. It is not typical. A significant lowering of red and white blood counts with radiation alone (no chemotherapy) is also not the norm, nor are fever and upper respiratory tract infections. A close dialogue with a treating radiation oncologist is paramount and it is unfortunate when patients do not have this relationship. Often times, coinciding medical issues, get mis-attributed to certain therapies when assessed by other caregivers. Again, a close relationship and constant interaction between patients and their treating physicians is of utmost importance. Lymphatic related issues can be exacerbated by radiation treatment (depending on whether older or newer techniques were utilized) and are a function of the lymph node dissection. It is important for patients to know that with state-of-the-art care and close relationships with their radiation oncologists that your experience falls into a very extreme category. Respectfully, it is also important to not have patients frightened away from treatment where for the most part, side effects are kept to a minimum, and local control and survival are significantly improved. At our center, patients are seen as often as a patient wants to be seen by their physician. We also employ educational workshops on nutrition, exercise, psychological healing during and after radiation therapy.
There is a lot of literature regarding treatment timing. It depends mostly on the type of reconstruction being performed. For example, autologous tissue (DIEP, TRAM) reconstruction is typically done prior to any radiation. With implants with or without tissue expanders, radiation therapy can be done either before or after the reconstruction. It is very important to discuss these possibilities with the entire team of surgeon, reconstructive surgeon, medical oncologist, and radiation oncologist beforehand.
At our center we follow our patients at multiple time intervals for at least up to 5-years. We recommend that patients follow with their breast surgeon and medical oncologist, as well. Typically any of those for physicians, or the gynecologist will schedule all follow-up diagnostic scans (mammogram, ultrasound, MRI).
There are several skin care options. Some of the topical creams and lotions we recommend include Aquaphor, Biafine, Mederma, and Jean's Cream. We also recommend the use of Aloe Vera (plant or gel) or vitamin E cream. Much of this is individualistic and a matter of comfort.
Some of the newest developments includes the use of Accuboost for localizing the tumor cavity for treating with radiation therapy. The machine is a modified version of a mammography unit with very mild compression and allows for very precise radiation treatment currently as a boost to external beam treatment. The possibility exists for doing this treatment as a 5-day twice a day protocol for 10 treatment or a once daily treatment course for 10 days as a protocol or off-label treatment. We are currently the only center in Manhattan that has the ability to do this technique.
Whether a patient has a bilateral mastectomy or a unilateral mastectomy, the indications for radiation are pretty much the same. It depends on the lymph node status, the size of the tumor, the margin status, and whether or not there is skin involvement. The menopausal status of the woman may also factor in.
The best approach to this is coordination with the radiation oncologist and reconstructive surgeon. Timing of radiation relative to surgery as well as completion of reconstruction relative to the end of radiation treatment. Depending on the type of reconstruction sometimes it is done prior to radiation, sometimes expanders are placed before radiation and then exchanged out at least six months after radiation is completed, and if autologous tissue reconstruction is performed, this is typically done prior to any radiation. Again, coordination is key and a plan for long term reconstruction is to be in place.
Some of the practices that we employ to minimizing damage to normal cells during breast radiation treatment includes precise target acquisition and minimization of movement along with patient monitoring. With regard to target acquisition, we use one of the best treatment machines, the Elekta Infinity which gives great images of the patient; one of the best CT-simulators, the new Toshiba large bore, which acquires very clear anatomical images; and we also use AccuBoost, the most precise way of locating the patient's lumpectomy cavity and treating that area (http://www.thefarbercenter.com/cancers/breast.php_). To monitor patients we utilize c-rad sentinel, which gives a laser topography image of the patient real time during treatment.
Yes to both parts. While the criteria for post-mastectomy radiation is evolving, it is often offered for tumors greater than or equal to 5 cm, positive or close margins, skin involvement, and involved lymph nodes. Historically, 4 or more lymph nodes positive were the indication with regard to lymph node positivity, however, recent studies have shown a benefit to post-mastectomy radiation even in patients with 1 to 3 lymph nodes positive, especially in pre-menopausal women. Also, if patients received pre-mastectomy chemotherapy, depending on their initial disease, post-mastectomy radiation may be indicated. We often deliver radiation with expanders in place, however, we require the expansion to be complete or not changed from the time the radiation is planned until after the treatment is completed.
Different physicians follow different guidelines for brachytherapy versus external beam radiation for breast cancer. We typically follow the American Brachytherapy Society guidelines for APBI: Age ≥ 50-years-old; Histology (Infiltrating Ductal Carcinoma); Clinical stage (T1, and T2 ≤ 3.0 cm, N0, M0: no distant metastases.) This is the website:http://www.americanbrachytherapy.org/guidelines/abs_breast_brachytherapy_taskgroup.pdf It is also very important that your surgeon is on board as often times closure of the lumpectomy cavity will factor in. As we are selective in which patients are good candidates, both types have been equally successful in my practice.
Please join TalkAboutHealth and you will be able to ask questions.
Your question to LeonardFarberMD:
2) Background Info (optional): What context or background information is relevant to this request?
The more clear and thorough your request, the more likely you will receive support.
Many of our members are learning from this information
or english might not be their first language.
Please use standard english and spell out all words.
For example, use 'you' instead of 'u'.
Thank you for sharing your question.
We will notify LeonardFarberMD.
Our topic related experts will review the question and will either answer right away, find the right specialist, or save the question for the next relevant Q&A workshop.
Responses will be sent to your email account as well as viewable at the
following link on TalkAboutHealth: