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Matt Katz, MD
MattKatzMD (Physician - Oncology - Radiation (Verified) )| Communities: Breast Cancer , Prostate Cancer , Lung Cancer , Brain Cancer | Answers: 27 |
| Member Since: Mar. 2011 |
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I am a community-based doctor learning how to use social media to improve cancer care and society. All content represents me, myself and I, none other.
I am a partner in Radiation Oncology Associates, practicing in southern New Hampshire and northern Massachusetts. I currently serve as Communicatoins Chair for the American Society of Radiation Oncology (ASTRO) and as a member of the External Advisory Board for Mayo Clinic Center for Social Media.
I am a partner in Radiation Oncology Associates, practicing in southern New Hampshire and northern Massachusetts. I currently serve as Communicatoins Chair for the American Society of Radiation Oncology (ASTRO) and as a member of the External Advisory Board for Mayo Clinic Center for Social Media.
Professional Info
Credential: MD
Primary specialty: Oncology - Radiation
State Licenses: MA, NH
Gender: Male
Medical school: University of Massacusetts
Residency: Memorial Sloan-Kettering Cancer Center
Practice name: Radiation Oncology Associates, PA
Practice address:
295 Varnum Avenue
Lowell, MA
01854
Practice phone number: (978) 937-6274
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There is a concern of second malignancy with radiation exposure that is real. But there are many factors including dose, time, and other factors. Men undergoing surgery are, on average, healthier than men receiving radiation -- younger, less smokers, less other health problems that may be linked to higher cancer rates.
Here is a recent publication from Memorial Sloan-Kettering, where I trained, in which there isn't a clear increased risk in the first decade: http://www.ncbi.nlm.nih.gov/pubmed/22889401 . Other research is out there you can find supporting or refuting this position. With longer time periods that risk may increase.
I typically have long discussions with men about the risks and benefits for second malignancy balance with many other health and quality of life outcomes that are important when deciding between surgery and radiation therapy. Both are effective treatments but a good understanding of the risks/benefits of each is important to make an informed choice.
Here is a recent publication from Memorial Sloan-Kettering, where I trained, in which there isn't a clear increased risk in the first decade: http://www.ncbi.nlm.nih.gov/pubmed/22889401 . Other research is out there you can find supporting or refuting this position. With longer time periods that risk may increase.
I typically have long discussions with men about the risks and benefits for second malignancy balance with many other health and quality of life outcomes that are important when deciding between surgery and radiation therapy. Both are effective treatments but a good understanding of the risks/benefits of each is important to make an informed choice.
New answer by MattKatzMD (Physician - Oncology - Radiation (Verified))
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3 months ago
Prone radiation isn't usually advertised so you'd have to call individual departments or practitioners. The American Society for Radiation Oncology provides a way to look for doctors in your area:
http://rtanswers.org/index.aspx
You can enter your address, and it will give you a listing of MDs in a certain radius that are convenient for you.
http://rtanswers.org/index.aspx
You can enter your address, and it will give you a listing of MDs in a certain radius that are convenient for you.
New answer by MattKatzMD (Physician - Oncology - Radiation (Verified))
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3 months ago
Separate from triple negative status, stage, menopausal status, margins play an important role in that conversation. Because there are data supporting a potential survival benefit to postmastectomy therapy radiation it's worth meeting with a radiation oncologist to review those pros and cons in person.
In general, cons are toxicity and inconvenience of radiation therapy. It also may affect reconstruction options for women who would like to do that later.
The American Society for Radiation Oncology has some information here, general but may be helpful:
http://rtanswers.org/treatmentinformation/cancertypes/breast/index.aspx
In general, cons are toxicity and inconvenience of radiation therapy. It also may affect reconstruction options for women who would like to do that later.
The American Society for Radiation Oncology has some information here, general but may be helpful:
http://rtanswers.org/treatmentinformation/cancertypes/breast/index.aspx
New answer by MattKatzMD (Physician - Oncology - Radiation (Verified))
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3 months ago
We are still distinguishing different strategies for radiation therapy based upon ER, PR, and Her2. Triple negative breast cancer (TNBC) tends to be higher grade and have a higher recurrence rate after lumpectomy even with radiation so it's still standard to treat.
The number of treatments is changing; I don't think there are great data on Canadian hypofractionation (16-21 treatments) vs. standard fractionation (30-33 treatments). Many rad oncs still have concerns about Canadian schedule for high grade tumors, so many still favor the long-established, longer regimen. There are a lot of variables including surgical margins, etc. that play a role. Each patient's needs are different.
Keep in mind, this all refers to whole breast radiation therapy. Partial breast irradiation is not really appropriate for TNBC in my opinion, but this is a newer approach so less likely an issue. Discuss with a doctor for specific reasons why a certain number of treatments may be optimal.
Similarly, it's an entirely different discussion if it's after mastectomy. But overall TNBC still warrants consideration of radiation therapy after surgery, but needs to be discussed on a case-by-case basis.
The number of treatments is changing; I don't think there are great data on Canadian hypofractionation (16-21 treatments) vs. standard fractionation (30-33 treatments). Many rad oncs still have concerns about Canadian schedule for high grade tumors, so many still favor the long-established, longer regimen. There are a lot of variables including surgical margins, etc. that play a role. Each patient's needs are different.
Keep in mind, this all refers to whole breast radiation therapy. Partial breast irradiation is not really appropriate for TNBC in my opinion, but this is a newer approach so less likely an issue. Discuss with a doctor for specific reasons why a certain number of treatments may be optimal.
Similarly, it's an entirely different discussion if it's after mastectomy. But overall TNBC still warrants consideration of radiation therapy after surgery, but needs to be discussed on a case-by-case basis.
New answer by MattKatzMD (Physician - Oncology - Radiation (Verified))
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3 months ago
Balloon radiotherapy for breast cancer, also known as intracavitary brachytherapy, can deliver a focused dose of radiation to part of the breast. The standard since the 1980s has been whole breast radiation therapy given over a period of a few weeks. With the balloon placed by the surgeon, radiation can be delivered twice a day for ten treatments to make treatment more focused and convenient.
This is one form of accelerated partial breast irradiation, or APBI. This technique is investigational but promising enough that it's reasonable to consider as an alternative to whole breast radiation therapy. Depending upon how conservative you are regarding medical evidence, it may be best done only on a clinical trial or there are guidelines for treatment off protocol in selected circumstances, which I have answered on TalkAboutHealth before:http://bit.ly/mZ2Fdg
I offer this treatment to selected women but tend to favor standard whole breast radiation. There's a fair amount of hype about APBI but it's still not proven to be equally effective. I'm not sure if this is the NY Times article you meant, but I'll discuss this: http://nyti.ms/wVW62K
Recent data presented at the San Antonio Breast Cancer Symposium showed that women receiving APBI were "about twice as likely to have a mastectomy in the following five years" after treatment compared to women receiving whole breast radiation. Sounds terrible, right? I call foul on the NY Times:
1. The failure rate almost doubled; 4% vs. 2.2%. Had the NY Times presented it based upon success rate, 96% vs 97.8%, it's not news.
2. It's a retrospective, broad stroke study. There can be all sorts of bias and no ability to account for quality control in how the treatment was done for APBI.
3. Presentations at academic meetings are interesting, but it's not finalized, peer-reviewed research until it's published.
I'm conservative regarding use of APBI. Don't believe the positive hype, but I don't put too much stock in the NY Times article. I hope that answers your question!
This is one form of accelerated partial breast irradiation, or APBI. This technique is investigational but promising enough that it's reasonable to consider as an alternative to whole breast radiation therapy. Depending upon how conservative you are regarding medical evidence, it may be best done only on a clinical trial or there are guidelines for treatment off protocol in selected circumstances, which I have answered on TalkAboutHealth before:http://bit.ly/mZ2Fdg
I offer this treatment to selected women but tend to favor standard whole breast radiation. There's a fair amount of hype about APBI but it's still not proven to be equally effective. I'm not sure if this is the NY Times article you meant, but I'll discuss this: http://nyti.ms/wVW62K
Recent data presented at the San Antonio Breast Cancer Symposium showed that women receiving APBI were "about twice as likely to have a mastectomy in the following five years" after treatment compared to women receiving whole breast radiation. Sounds terrible, right? I call foul on the NY Times:
1. The failure rate almost doubled; 4% vs. 2.2%. Had the NY Times presented it based upon success rate, 96% vs 97.8%, it's not news.
2. It's a retrospective, broad stroke study. There can be all sorts of bias and no ability to account for quality control in how the treatment was done for APBI.
3. Presentations at academic meetings are interesting, but it's not finalized, peer-reviewed research until it's published.
I'm conservative regarding use of APBI. Don't believe the positive hype, but I don't put too much stock in the NY Times article. I hope that answers your question!
New answer by MattKatzMD (Physician - Oncology - Radiation (Verified)) in topic(s) Radiation Therapy, Brachytherapy, Intracavitary Brachytherapy, Accelerated Partial Breast Irradiation (APBI), Breast Cancer Radiation Therapy, Balloon Radiotherapy, Internal Radiation, Cancer Treatments
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1 year ago
Jacqueline, thanks so much for asking, I really appreciate it. It was a labor of love to make the website.
I made CaP Calculator a few years ago to help better determine the extent of prostate cancer spread, based upon published research. The idea was that it could help clinicians make personalized, evidence-based assessments to show to men with prostate cancer and promote shared decision-making.
It's not a validated tool, and it's really only designed for clinicians at this point. But I'll see if I can video something and post it over the next week or so.
I made CaP Calculator a few years ago to help better determine the extent of prostate cancer spread, based upon published research. The idea was that it could help clinicians make personalized, evidence-based assessments to show to men with prostate cancer and promote shared decision-making.
It's not a validated tool, and it's really only designed for clinicians at this point. But I'll see if I can video something and post it over the next week or so.
New answer by MattKatzMD (Physician - Oncology - Radiation (Verified))
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1 year ago
Funny you ask, I don't know! We haven't surveyed doctors using CaP Calculator. Anecdotally, I've gotten positive feedback from users and no major complaints. However, it's not widely used. The MSKCC nomograms are much more established and probably a better choice.
http://www.mskcc.org/cancer-care/adult/prostate/prediction-tools
http://www.mskcc.org/cancer-care/adult/prostate/prediction-tools
New answer by MattKatzMD (Physician - Oncology - Radiation (Verified))
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1 year ago
Good question, complex answer. I'll do my best.
In early stage cervical cancer, surgery is often possible but sometimes an organ-preserving approach is preferable and radiation can be used alone. In more advanced disease, surgery isn't possible but cure still is, so radiation is combined often with chemotherapy.
In these cases, radiation can be given partly with external x-rays, but to focus the dose some internal radiation treatment is also given. Usually, this is intracavitary brachytherapy (meaning close treatment in a cavity) by placing radioactive sources into the vagina, cervix and uterus.
Historically, radium was used. In the past 20 years, most of the brachytherapy has been with Cesium-137. Treatment required going to the operating room to place the applicator that would hold the radioactive sources, then determining how much Cesium to place internally for a period of 2-3 days while hospitalized. This is often referred to as LDR (low dose rate) brachytherapy because it's delivered slowly over time.
More recently there has been a move toward pulsed doses of HDR (high dose rate) brachytherapy with an Ir-192 source. This seems to be an equally effective approach with more radiation safety than LDR, but there are supporters for both approaches. The treatments are short but often more internal treatments are needed with HDR.
In early stage cervical cancer, surgery is often possible but sometimes an organ-preserving approach is preferable and radiation can be used alone. In more advanced disease, surgery isn't possible but cure still is, so radiation is combined often with chemotherapy.
In these cases, radiation can be given partly with external x-rays, but to focus the dose some internal radiation treatment is also given. Usually, this is intracavitary brachytherapy (meaning close treatment in a cavity) by placing radioactive sources into the vagina, cervix and uterus.
Historically, radium was used. In the past 20 years, most of the brachytherapy has been with Cesium-137. Treatment required going to the operating room to place the applicator that would hold the radioactive sources, then determining how much Cesium to place internally for a period of 2-3 days while hospitalized. This is often referred to as LDR (low dose rate) brachytherapy because it's delivered slowly over time.
More recently there has been a move toward pulsed doses of HDR (high dose rate) brachytherapy with an Ir-192 source. This seems to be an equally effective approach with more radiation safety than LDR, but there are supporters for both approaches. The treatments are short but often more internal treatments are needed with HDR.
New answer by MattKatzMD (Physician - Oncology - Radiation (Verified)) in topic(s) Radiation Therapy, Cervical Cancer, Radiation Oncology, Radium Implants
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1 year ago
Active surveillance is an increasingly attractive option to consider for men with newly diagnosed, low risk prostate cancer. I went to a conference last April at Memorial Sloan-Kettering, and this is a real dilemma - some estimated as many as 30-40% of men with newly diagnosed prostate cancer may not need treatment.
So how do you know if active surveillance (AS) is the right choice? Part of that is the disease. Generally to be a good candidate for AS means being in a low risk category. Another key part is the patient's approach. It's essential to really have an in-depth discussion because the risk-benefit analysis differs for each person. Shared decision-making between doctor and patient is key (and spouse/partner, if he wants). Each conversation I have on this topic is different because people's values are different.
So how do you know if active surveillance (AS) is the right choice? Part of that is the disease. Generally to be a good candidate for AS means being in a low risk category. Another key part is the patient's approach. It's essential to really have an in-depth discussion because the risk-benefit analysis differs for each person. Shared decision-making between doctor and patient is key (and spouse/partner, if he wants). Each conversation I have on this topic is different because people's values are different.
New answer by MattKatzMD (Physician - Oncology - Radiation (Verified))
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1 year ago
Prostate cancer is usually diagnosed by biopsy. While MRI may be increasingly helpful in defining where the cancer is within the gland, currently there is no reliable test to be sure. Because biopsies are just samples, it's not always accurate and sometimes more can be seen with surgery where biopsies had been negative.
For that reason, both surgery and radiation aim to treat the entire prostate gland, not just parts of it. If we get better with diagnostic testing and staging maybe we can get there, but for now typically the entire gland requires treatment if curative treatment is being considered.
For that reason, both surgery and radiation aim to treat the entire prostate gland, not just parts of it. If we get better with diagnostic testing and staging maybe we can get there, but for now typically the entire gland requires treatment if curative treatment is being considered.
New answer by MattKatzMD (Physician - Oncology - Radiation (Verified))
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1 year ago
Gleason score is a measure of aggressiveness in prostate cancer. Although the scale goes from 2-10, in practice it's usually 6-10. The higher the score, the more aggressive the tumor.
For radiation treatment, there are many factors helping with decisions. Gleason score is one, but others include clinical stage, how much cancer was on the biopsies, the PSA level, and other factors like perineural invasion (tumor on a nerve seen in the biopsy). In aggregate, these factors may influence decisions about the appropriate radiation fields and radiation dose.
For radiation treatment, there are many factors helping with decisions. Gleason score is one, but others include clinical stage, how much cancer was on the biopsies, the PSA level, and other factors like perineural invasion (tumor on a nerve seen in the biopsy). In aggregate, these factors may influence decisions about the appropriate radiation fields and radiation dose.
New answer by MattKatzMD (Physician - Oncology - Radiation (Verified))
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1 year ago
Great question. MRI (magnetic resonance imaging) is an alternative to CT scans to look at the prostate and pelvic lymph nodes. MRI gives better definition of the prostate than CT, and it may help with more accurate clinical staging. Some academic radiologists feel strongly that it can potentially guide treatment decisions for surgery or radiation.
While I think MRIs can be helpful, there are some serious issues with it being widely used:
1. It's expensive and not always covered by insurance.
2. 1.5 Tesla MRIs require men to have something inserted into the rectum to get quality images. 3 Tesla
MRIs are newer and less available so many men may not want to go through it.
3. The images need to be reviewed by radiologists with a lot of experience/interest in prostate MRI because it's not that common. Experience matters in how the images are evaluated/interpreted to be of any value clinically.
It can be helpful in radiation treatment planning, but it's a diagnostic test. So the indiciations should be whether it changes treatment decisions. My sense is that the jury is out for wide adoption.
While I think MRIs can be helpful, there are some serious issues with it being widely used:
1. It's expensive and not always covered by insurance.
2. 1.5 Tesla MRIs require men to have something inserted into the rectum to get quality images. 3 Tesla
MRIs are newer and less available so many men may not want to go through it.
3. The images need to be reviewed by radiologists with a lot of experience/interest in prostate MRI because it's not that common. Experience matters in how the images are evaluated/interpreted to be of any value clinically.
It can be helpful in radiation treatment planning, but it's a diagnostic test. So the indiciations should be whether it changes treatment decisions. My sense is that the jury is out for wide adoption.
New answer by MattKatzMD (Physician - Oncology - Radiation (Verified))
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1 year ago
Radiation treatment can be an effective curative treatment for prostate cancer, in many cases equally as effective as surgery. IMRT is an advanced form of 3D conformal radiation that allows the dose to be more precisely shaped to the prostate, giving less dose to the rectum, hips, and bladder. The improved precision has allowed higher radiation doses to be given more safely, so that biochemical cure rates are higher and there is a moderate reduction is bowel and urinary side effects.
The main organs getting radiation exposure depend upon the radiation fields. The prostate is always treated, sometimes the seminal vesicles and less commonly the lymph nodes. As the fields get larger, more normal tissue gets radiation even with IMRT.
Typical side effects develop during the weeks of radiation: urinary obstructive or irritative symptoms, loose bowels or urgency, less commonly hemorrhoid flares or fatigue. These settle down usually but a minority of men need medication for urinary obstructive symptoms. Serious complications are rare but the bowel effects from radiation aren't seen with surgery. Incontinence rates are lower with radiation than surgery for the first decade but may rise in the second decade after treatment. Erectile dysfunction is common with both IMRT and surgery. Rarely are there other side effects. Second cancers (mainly rectal) may rarely occur from radiation; that's the big one but occurs years later if at all.
For more information, you can look at a lot of resources: National Cancer Institute, American Cancer Society and ASTRO all have good information. Here's a link to ASTRO's information:http://bit.ly/xOobdH
The main organs getting radiation exposure depend upon the radiation fields. The prostate is always treated, sometimes the seminal vesicles and less commonly the lymph nodes. As the fields get larger, more normal tissue gets radiation even with IMRT.
Typical side effects develop during the weeks of radiation: urinary obstructive or irritative symptoms, loose bowels or urgency, less commonly hemorrhoid flares or fatigue. These settle down usually but a minority of men need medication for urinary obstructive symptoms. Serious complications are rare but the bowel effects from radiation aren't seen with surgery. Incontinence rates are lower with radiation than surgery for the first decade but may rise in the second decade after treatment. Erectile dysfunction is common with both IMRT and surgery. Rarely are there other side effects. Second cancers (mainly rectal) may rarely occur from radiation; that's the big one but occurs years later if at all.
For more information, you can look at a lot of resources: National Cancer Institute, American Cancer Society and ASTRO all have good information. Here's a link to ASTRO's information:http://bit.ly/xOobdH
New answer by MattKatzMD (Physician - Oncology - Radiation (Verified))
1
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1 year ago
This is an excellent question! We don't have enough good information to say yet, but it's important we get answers because many cancer patients do take vitamin supplements or other complementary therapies.
While some of the potential benefits are there theoretically, the question is whether it works in practice. One concern I have in radiation oncology is antioxidants, because a clinical trial in head and neck cancer showed no lessening of toxicity and higher recurrence rates in patients using Vitamin E with radiation.
http://www.ncbi.nlm.nih.gov/pubmed/16841333 . For dietary, the data are mixed and limited on the benefits of honeyhttp://www.ncbi.nlm.nih.gov/pubmed/21636188.
Different research is available for different diseases. And while some naturopathic therapies may have potency, the issue is also one of quality control. If you can't consistently get the same amount in one lot vs. another, then it's very difficult to be sure taking these supplements will make a difference.
Final take home: discuss with your doctor all nonprescription drugs, supplements you take and any other complementary therapies. Discuss it. Maybe it's fine to continue, but check first with your doctor before starting radiation treatments.
While some of the potential benefits are there theoretically, the question is whether it works in practice. One concern I have in radiation oncology is antioxidants, because a clinical trial in head and neck cancer showed no lessening of toxicity and higher recurrence rates in patients using Vitamin E with radiation.
http://www.ncbi.nlm.nih.gov/pubmed/16841333 . For dietary, the data are mixed and limited on the benefits of honeyhttp://www.ncbi.nlm.nih.gov/pubmed/21636188.
Different research is available for different diseases. And while some naturopathic therapies may have potency, the issue is also one of quality control. If you can't consistently get the same amount in one lot vs. another, then it's very difficult to be sure taking these supplements will make a difference.
Final take home: discuss with your doctor all nonprescription drugs, supplements you take and any other complementary therapies. Discuss it. Maybe it's fine to continue, but check first with your doctor before starting radiation treatments.
New answer by MattKatzMD (Physician - Oncology - Radiation (Verified))
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1 year ago
Radioisotopes can be used for a variety of purposes. Radiopharmaceuticals emit ionizing radiation over time. The most common types used are Iodine-131 for the treatment of thyroid cancer (usually a pill that's swallowed) and I-125 embedded in seeds permanently implanted to treat prostate cancer [seed implant]. Others, such as Yttrium-90, can be given selectively in some lymphomas and colorectal cancer while Samarium-153 can be used for multiple bone metastases for prostate cancer.
it's still a small part of cancer care, but likely this will be increasingly important as molecular medicine helps us better define how to target radiation internally.
it's still a small part of cancer care, but likely this will be increasingly important as molecular medicine helps us better define how to target radiation internally.
New answer by MattKatzMD (Physician - Oncology - Radiation (Verified))
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1 year ago
Crizotinib, also known is Xalkori, is a new target drug therapy that helps improve response rates and survival for a select group of patients with stage IV non-small cell lung cancer with ALK gene translocations:
http://www.ncbi.nlm.nih.gov/pubmed/20979469
http://www.ncbi.nlm.nih.gov/pubmed/21933749
In stage IV lung cancer, radiation is used palliatively, to relieve symptoms and improve quality of life. Currently there are no peer-reviewed data I'm aware of suggesting that crizotinib has positive or negative interactions with radiation in this setting. This will be an important question to answer in time, particularly if one were to consider doing both treatments at the same time. If helpful, it may be worth considering in clinical trials for stage III ALK+ cancers treated with chemotherapy and radiation. We'll see what future research reveals.
http://www.ncbi.nlm.nih.gov/pubmed/20979469
http://www.ncbi.nlm.nih.gov/pubmed/21933749
In stage IV lung cancer, radiation is used palliatively, to relieve symptoms and improve quality of life. Currently there are no peer-reviewed data I'm aware of suggesting that crizotinib has positive or negative interactions with radiation in this setting. This will be an important question to answer in time, particularly if one were to consider doing both treatments at the same time. If helpful, it may be worth considering in clinical trials for stage III ALK+ cancers treated with chemotherapy and radiation. We'll see what future research reveals.
New answer by MattKatzMD (Physician - Oncology - Radiation (Verified))
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1 year ago
Ionizing radiation has the potential to cause side effects years later after treatment, which is why long-term followup with doctors can be important as part of survivorship care.
In breast cancer, there should be no effect anticipated on the thyroid if the neck is not in the radiation field. This is true when women (or men) are treated to the breast or chest wall only. When additional treatment is given to the supraclavicular nodes (in the shoulder area, around the collar bone), the field may treat some of the thyroid or near it.
Data from MD Anderson do not show a definite link between radiation and thyroid problems later in life. However, a Norwegian study did and suggested it may be worth screening for low thyroid function (hypothyroidism). Here are links to the studies:
MDACC: http://www.ncbi.nlm.nih.gov/pubmed/18213620
Norway: http://www.ncbi.nlm.nih.gov/pubmed/19286332
A followup study by the Norwegians do indicate that it may be a higher risk in women with small thyroid glands:
http://www.ncbi.nlm.nih.gov/pubmed/21651829
It's not definitive by any means. Because hypothyroidism is relatively common, it's not possible to be certain. But there may be some emerging evidence to suggest that it is a clinically relevant issue worth further study to decide whether routine screening is needed.
In breast cancer, there should be no effect anticipated on the thyroid if the neck is not in the radiation field. This is true when women (or men) are treated to the breast or chest wall only. When additional treatment is given to the supraclavicular nodes (in the shoulder area, around the collar bone), the field may treat some of the thyroid or near it.
Data from MD Anderson do not show a definite link between radiation and thyroid problems later in life. However, a Norwegian study did and suggested it may be worth screening for low thyroid function (hypothyroidism). Here are links to the studies:
MDACC: http://www.ncbi.nlm.nih.gov/pubmed/18213620
Norway: http://www.ncbi.nlm.nih.gov/pubmed/19286332
A followup study by the Norwegians do indicate that it may be a higher risk in women with small thyroid glands:
http://www.ncbi.nlm.nih.gov/pubmed/21651829
It's not definitive by any means. Because hypothyroidism is relatively common, it's not possible to be certain. But there may be some emerging evidence to suggest that it is a clinically relevant issue worth further study to decide whether routine screening is needed.
New answer by MattKatzMD (Physician - Oncology - Radiation (Verified))
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1 year ago
I'm not really familiar with thermography, but despite the appeal of avoiding exposure to ionizing radiation it's just not proven to be effective yet.
It needs rigorous testing, which is why it's not FDA approved yet. At least one study show poor sensitivity -http://www.ncbi.nlm.nih.gov/pubmed/21377664
And now MRI can do some thermal imaging, but this too needs careful testing:http://www.ncbi.nlm.nih.gov/pubmed/20432295
There is no perfect test, and adding more tests may make it more confusing and stressful. So how do I feel? Stick with the evidence, not the anecdote.
It needs rigorous testing, which is why it's not FDA approved yet. At least one study show poor sensitivity -http://www.ncbi.nlm.nih.gov/pubmed/21377664
And now MRI can do some thermal imaging, but this too needs careful testing:http://www.ncbi.nlm.nih.gov/pubmed/20432295
There is no perfect test, and adding more tests may make it more confusing and stressful. So how do I feel? Stick with the evidence, not the anecdote.
New answer by MattKatzMD (Physician - Oncology - Radiation (Verified)) in topic(s) Breast Cancer Screening, Mammagram, Breast Cancer, Breast Cancer Imaging, Thermography, Breast Imaging, Mammography
6
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1 year ago
Hi Jody:
Thanks for asking. Before I touch on the differences, let's discuss what they have in common:
* they are treatment devices used to give focused radiation after lumpectomy;
* both are balloons with catheters inflated inside the surgical site that bend to varying degrees;
The radiation technique is called intracavitary brachytherapy (inside the cavity, 'close' treatment) for both devices.
There are some technical differences. MammoSite originally had only a single channel for radition inside the catheter so it couldn't 'shape' the radiation as easily as Contura, which has multiple channels. However, that means that to accomodate multiple channels the catheter is thicker, and so is the hole in the skin present during the treatments. MammoSite has come out with a competing multi-channel product, and there are others as well. There have been no randomized trials comparing the benefits of one vs the other to suggest meaningful differences.
Who benefits? Women who are considered candidates for accelerated partial breast irradiation (APBI). Currently this technique seems to be favored over external radiation or another kind of brachytherapy. To understand APBI you can look at my prior answer.http://bit.ly/mZ2Fdg
Thanks for asking. Before I touch on the differences, let's discuss what they have in common:
* they are treatment devices used to give focused radiation after lumpectomy;
* both are balloons with catheters inflated inside the surgical site that bend to varying degrees;
The radiation technique is called intracavitary brachytherapy (inside the cavity, 'close' treatment) for both devices.
There are some technical differences. MammoSite originally had only a single channel for radition inside the catheter so it couldn't 'shape' the radiation as easily as Contura, which has multiple channels. However, that means that to accomodate multiple channels the catheter is thicker, and so is the hole in the skin present during the treatments. MammoSite has come out with a competing multi-channel product, and there are others as well. There have been no randomized trials comparing the benefits of one vs the other to suggest meaningful differences.
Who benefits? Women who are considered candidates for accelerated partial breast irradiation (APBI). Currently this technique seems to be favored over external radiation or another kind of brachytherapy. To understand APBI you can look at my prior answer.http://bit.ly/mZ2Fdg
New answer by MattKatzMD (Physician - Oncology - Radiation (Verified)) in topic(s) Breast Cancer Radiation Treatment, Radiation, Breast Cancer Radiation Therapy, Breast Cancer Radiation Oncology, Internal Radiation Therapy (IRT), Contura, Brachytherapy, Radiation Therapy, Accelerated Partial Breast Irradiation (APBI), Breast Cancer Internal Radiation Therapy (IRT), Radiation Treatment, MammoSite, Radiation Oncology
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1 year ago
Hi AK:
Good question. Short answer: it varies. Long answer:
For newly diagnosed breast cancer, radiation is most often used after surgery. As a result, there is nothing objectively measurable left of the tumor. Unless physical exam gives reason to suspect a recurrence before radiation has begun, usually no testing is performed. CT scans used to plan radiation therapy can identify the postoperative area but can't distinguish tumor from normal breast tissue.
In some other tumors, like lung cancer, it's clearer that the tumor appears abnormal on chest x-ray, CT or PET scan. However, imaging alone is usually not enough and biopsy is needed to confirm.
Good question. Short answer: it varies. Long answer:
For newly diagnosed breast cancer, radiation is most often used after surgery. As a result, there is nothing objectively measurable left of the tumor. Unless physical exam gives reason to suspect a recurrence before radiation has begun, usually no testing is performed. CT scans used to plan radiation therapy can identify the postoperative area but can't distinguish tumor from normal breast tissue.
In some other tumors, like lung cancer, it's clearer that the tumor appears abnormal on chest x-ray, CT or PET scan. However, imaging alone is usually not enough and biopsy is needed to confirm.
New answer by MattKatzMD (Physician - Oncology - Radiation (Verified)) in topic(s) Radiation Therapy, Radiation, Radiation Treatment, Radiology
1
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1 year ago
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