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Noushin Hart, MD
NoushinHartMD (Physician - Oncology - Radiation (Verified) )| Communities: Breast Cancer , Cervical Cancer , Ovarian Cancer , Uterine and Endometrial Cancer | Answers: 34 |
| Member Since: Feb. 2012 |
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Professional Statement
Dr. Noushin Izadifar Hart is a Board Certified Radiation Oncologist with special interest in breast and gynecological cancers, as well as clinical cancer genetics. Dr. Hart completed medical school in 1986 in Iran. As a general practitioner, she practiced medicine for several years before starting her residency in radiation oncology. She moved to United States in January of 1994 and completed a year of internship at Medical College of Pennsylvania in Philadelphia before starting her residency in radiation oncology at one of the foremost centers at Mallinckrodt Institute of Radiology at Washington University in St. Louis. She also completed a year of research fellowship at the same institution where she studied advantages of Three-Dimensional Conformal Radiation Therapy in treating Head and Neck Cancers.
Upon completion of her residency and fellowship, Dr. Hart joined the department of radiation oncology at Loyola University of Chicago where she served as an assistant professor and chief of breast, GYN and brachytherapy services. She was also in charge of lymphoma and Total Body Irradiation as a part of the Bone Marrow Transplantation program. She implemented High Dose Rate (HDR) brachytherapy for treatment of GYN and breast cancers. After participating in national research protocols studying Endovascular Brachytherapy, she also started that program for Loyola University of Chicago.
During her residency, fellowship and academic practice, Dr. Hart has performed clinical research in Three Dimensional Conformal Radiation Therapy, Intensity Modulated Radiation Therapy, Endovascular Brachytherapy, gynecological and breast malignancies. Dr. Hart, who was trained at one of the very few residency programs with IMRT technology, has vast experience with the newest technologies in radiation oncology and has used IMRT and IGRT technology for treatment of breast and GYN cancers extensively.
Upon completion of her residency and fellowship, Dr. Hart joined the department of radiation oncology at Loyola University of Chicago where she served as an assistant professor and chief of breast, GYN and brachytherapy services. She was also in charge of lymphoma and Total Body Irradiation as a part of the Bone Marrow Transplantation program. She implemented High Dose Rate (HDR) brachytherapy for treatment of GYN and breast cancers. After participating in national research protocols studying Endovascular Brachytherapy, she also started that program for Loyola University of Chicago.
During her residency, fellowship and academic practice, Dr. Hart has performed clinical research in Three Dimensional Conformal Radiation Therapy, Intensity Modulated Radiation Therapy, Endovascular Brachytherapy, gynecological and breast malignancies. Dr. Hart, who was trained at one of the very few residency programs with IMRT technology, has vast experience with the newest technologies in radiation oncology and has used IMRT and IGRT technology for treatment of breast and GYN cancers extensively.
Professional Info
Credential: MD
Primary specialty: Oncology - Radiation
Residency: Washington University in St. Louis
Internship: Medical College of Pennsylvania
Practice name: Hart to Heart Cancer Consultants
Webpage:
http://h2hcc.com/
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Personal Bio (My story)
Dr. Hart is a patient advocate and holds the best interest of every patient as her top priority. She believes in empowering her patients with the knowledge to overcome the fears caused by myths surrounding cancer and the required treatments. Throughout her career she has initiated cancer education programs and support groups for cancer survivors and their families.
After more than a decade of providing cancer treatments, Dr. Hart has recognized the crucial role of preventive measures. She strongly believes that for every life saved by cancer treatments, many more are saved by emphasis on prevention and early detection. That is the very reason for founding Hart to Heart Cancer Consultants.
After more than a decade of providing cancer treatments, Dr. Hart has recognized the crucial role of preventive measures. She strongly believes that for every life saved by cancer treatments, many more are saved by emphasis on prevention and early detection. That is the very reason for founding Hart to Heart Cancer Consultants.
NoushinHartMD Activities
"Stomach bloating" is not a known side effect of breast irradiation. Tightness of skin can be treated with a variety of cremes or lotions along with massaging the area of tightness. Tightness of the skin is the result of scar tissue in the area and may be treated with what is used to treat scar tissue.
New answer by NoushinHartMD (Physician - Oncology - Radiation (Verified))
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1 month ago
This is a very general question and can only be answered based on the type and stage of a cancer. Depending on these two factors, sometimes radiation therapy and systemic therapy are delivered concurrently or they may be used sequentially. As an example if the mediastinal and supraclavicular lymph nodes are irradiated because of lung cancer it may be given at the same time as chemotherapy. If these lymph nodes are irradiated because of involvement with lymphoma, one may receive chemotherapy first and then radiation therapy. SBRT is often used to treat a rather small area, either the primary tumor or metastasis and is not used to cover all mediastinal and/or supraclavicular lymph nodes.
New answer by NoushinHartMD (Physician - Oncology - Radiation (Verified))
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1 month ago
Radiation therapy for inflammatory breast cancer includes irradiation of supraclavicular lymph nodes. If Three-Dimensional radiation planning is used to plan your radiation, the dose to the brachial plexus would be calculated before you start your radiation. Each critical organ can tolerate a safe dose of radiation and during planning of radiation therapy, every effort would be made to keep the dose to that organ below its tolerance. By respecting the normal tissue tolerance, the risk of injury to these organs, including brachial plexus is very low.
New answer by NoushinHartMD (Physician - Oncology - Radiation (Verified))
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1 month ago
The recommendation for post-mastectomy radiation is not based on Estrogen Receptor, Progesterone Receptor or HER2/neu status (a triple negative breast cancer is one with all of these three negative). It is rather based on the size of the tumor, number of lymph nodes involved by the cancer, status of margin of resection, multicentricity of the tumor, skin involvement, and whether the cancer was an inflammatory one or not. So even though an educated guess may be made on the pathological status of the cancer, the final stage is determined after the mastectomy is completed and a pathologist reviews all these factors in the specimen.
New answer by NoushinHartMD (Physician - Oncology - Radiation (Verified))
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1 month ago
The longer the interval between surgery and/or chemotherapy and start of radiation therapy, the less effective radiation therapy may become. If radiation is given right after surgery, we often wait about 6-8 weeks to make sure the healing has taken place. The timing is often coordinated between the surgeon and the radiation oncologist. If the radiation is given after chemotherapy, depending on the chemotherapy agent, one may leave 2-4 weeks interval between the two. But concurrent chemotherapy and radiation therapy may be recommended as well.
New answer by NoushinHartMD (Physician - Oncology - Radiation (Verified))
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1 month ago
For cervical cancer, there are certain factors that predict high risk of recurrence after a surgical resection. Studies have shown that addition of radiation therapy (and in some cases concurrent chemotherapy) would significantly reduce risk of recurrence. These high risk factors include positive surgical margins, parametrial involvement, deep stromal invasion, lymphovascular invasion, tumors larger than 4 centimeter, pelvic lymph node involvement, and periaortic lymph node involvement.
New answer by NoushinHartMD (Physician - Oncology - Radiation (Verified))
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9 months ago
NoushinHartMD (Physician - Oncology - Radiation (Verified)) asked the question
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9 months ago
In practice of oncology, preserving an organ has either served a cosmetic reason or a functional one. For example breast conservation has merely served a cosmetic purpose but limb preservation in treatment of sarcomas, has served the purpose of preserving the function of a limb. When it comes to preserving the cervix, it's preservation has only been important in younger women who have desired to remain fertile. So that is the only scenario when surgery would not be the treatment of choice. That is for early stage cervical cancer. As for later stage cervical cancer, surgical resection would not be at the best interest of the patient because complete resection of the tumor would not be possible and patient would require radiation and chemotherapy even after surgery. In that case, patient would most likely experience side effects of all three treatment modalities without additional benefit from surgery.
When it comes to organ preservation, the other very important factor to keep in mind is that one should not preserve an organ just for the sake of preserving it if that organ is not going to function as result of organ-preserving treatments! For example, what good is preserving a cervix would do to fertility of a woman if their ovaries are going to be non-functional as result of receiving radiation to their pelvis? Therefore, every patient's case has to be discussed individually. One has to know the stage of the disease, the baseline function of the organ to begin with, how the treatments would affect the function of the organ one is trying to preserve but above all, how successful the treatments are going to be in eliminating the disease without compromising the outcomes.
When it comes to organ preservation, the other very important factor to keep in mind is that one should not preserve an organ just for the sake of preserving it if that organ is not going to function as result of organ-preserving treatments! For example, what good is preserving a cervix would do to fertility of a woman if their ovaries are going to be non-functional as result of receiving radiation to their pelvis? Therefore, every patient's case has to be discussed individually. One has to know the stage of the disease, the baseline function of the organ to begin with, how the treatments would affect the function of the organ one is trying to preserve but above all, how successful the treatments are going to be in eliminating the disease without compromising the outcomes.
New answer by NoushinHartMD (Physician - Oncology - Radiation (Verified))
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9 months ago
NoushinHartMD (Physician - Oncology - Radiation (Verified)) asked the question
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9 months ago
In treatment of cervical cancer, unless the tumor has been surgically removed and the radiation is given postoperatively, internal radiation is always a crucial part of the treatment. The reason for that is that with external radiation alone we would not be able to deliver the required doses of radiation to the tumor at the cervix without exceeding the safe tolerated doses of normal tissues within the pelvis. On the other hand by using internal radiation, we can deliver relatively high doses of radiation to the tumor while sparing most of organs within the pelvis. So the standard radiation for cervical cancer always consists of a combination of five weeks of external beam followed by internal radiation.
New answer by NoushinHartMD (Physician - Oncology - Radiation (Verified))
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9 months ago
NoushinHartMD (Physician - Oncology - Radiation (Verified)) asked the question
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9 months ago
Traditionally external radiation for treating cervical cancer was given with four-field technique. That is radiation beams were directed from anterior, posterior, right and left lateral directions. This technique did not spare any of organs inside the pelvis. With the invention of CAT scans, three-dimensional radiation therapy was developed. This technology was a CT-based radiation planning system which allowed sparing of normal tissues to some extent. Later on a sophisticated form of 3D conformal radiation therapy, called Intensity Modulated Radiation Therapy or IMRT was developed. This form of radiation planning software is an inverse planning system which begins with a desired dose distribution and arrives at a specification of the required fluence modulation to create it. Obviously the more sophisticated these technologies get, the more successfully we can spare the normal tissues surrounding the target of radiation. Nowadays an even more sophisticated technology called RapidArc Therapy, not only improves dose conformity but also significantly shortens treatment times. Volumetric modulated arc therapy differs from existing techniques like IMRT because it delivers dose to the whole volume, rather than slice by slice and the treatment planning algorithm ensures the treatment precision, helping to spare normal healthy tissue.
New answer by NoushinHartMD (Physician - Oncology - Radiation (Verified))
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9 months ago
NoushinHartMD (Physician - Oncology - Radiation (Verified)) asked the question
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9 months ago
For treating cervical cancer, often a combination of external and internal radiation therapy is utilized. For internal radiation special brachytherapy applicators called Tandem and Ovoid are used. Tandem is an applicator which is inserted through the cervical os into the uterus. Ovoids are a pair of applicators which are placed in the vaginal fornices, one on each side of the cervix. Using either Low Dose Rate or High Dose Rate brachytherapy systems, radioactive sources would be inserted into these applicators. These radioactive sources would deliver high doses of radiation to the tumor at the cervix with relatively small doses to the other organs in the pelvis. Internal radiation is a crucial part of curative treatment of cervical cancer.
New answer by NoushinHartMD (Physician - Oncology - Radiation (Verified))
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9 months ago
NoushinHartMD (Physician - Oncology - Radiation (Verified)) asked the question
1
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9 months ago
Traditionally external radiation for treating endometrial cancer was given with four-field technique. That is radiation beams were directed from anterior, posterior, right and left lateral sides. This technique did not spare any of organs within pelvis. With the invention of CAT scans, three-dimensional radiation therapy was developed. This technology was a CT-based treatment planning system which allowed sparing of adjacent normal tissues to some extent. Later on a sophisticated form of 3D conformal radiation therapy, called Intensity Modulated Radiation Therapy or IMRT was developed. This form of radiation planning software is an inverse planning system which begins with a desired dose distribution and arrives at a specification of the required fluence modulation to create it. Obviously the more sophisticated these technologies get, the more successfully we can spare the normal tissues surrounding the target of radiation.
New answer by NoushinHartMD (Physician - Oncology - Radiation (Verified)) in topic(s) External Radiation, Treatment Options, 3D Conformal Radiation Therapy, Endometrial Cancer Treatment Options, Radiation Therapy, External-beam Radiation, Intensity Modulated Radiation Therapy (IMRT), Localized Radiation, Radiation Treatment Options, Radiation Oncology, Uterine Cancer Treatment Options, Radiation Treatments, Endometrial Cancer
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11 months ago
NoushinHartMD (Physician - Oncology - Radiation (Verified)) asked the question in topic(s) External Radiation, Treatment Options, 3D Conformal Radiation Therapy, Endometrial Cancer Treatment Options, Radiation Therapy, External-beam Radiation, Intensity Modulated Radiation Therapy (IMRT), Localized Radiation, Radiation Treatment Options, Radiation Oncology, Uterine Cancer Treatment Options, Radiation Treatments, Endometrial Cancer
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11 months ago
What would determine the target of radiation therapy after a mastectomy depends on the pathological findings at the time of mastectomy if patient has not received any chemotherapy prior to her mastectomy and the clinical findings prior to the mastectomy if patient has received chemotherapy prior to the mastectomy. The clinical findings prior to the mastectomy as well as the pathological findings in the surgical specimen would suggest what would be the areas at highest risk of a recurrence. This would be an educated guess based on natural history of the disease and years of research and therefore data and statistics.
Generally speaking the most common sites of recurrence after a mastectomy are mastectomy scar, followed by supraclavicular nodes, followed by the axillary nodes. So the minimum area covered by radiation would be the chest wall including the mastectomy scar. Whether the regional lymph nodes including supraclavicular nodes and axillary nodes need to be irradiated or not depends on individual patient and subject to review of each patient's clinical presentation and review of pathology and details of surgical procedure including whether the patient had undergone sentinel lymph node biopsy or a full axillary dissection and many other factors including biological markers defining level of aggression of the disease, etc. One size does not fit all and multidisciplinary conferences are where medical teams discuss the best approach for each patient and offer individualized care.
Generally speaking the most common sites of recurrence after a mastectomy are mastectomy scar, followed by supraclavicular nodes, followed by the axillary nodes. So the minimum area covered by radiation would be the chest wall including the mastectomy scar. Whether the regional lymph nodes including supraclavicular nodes and axillary nodes need to be irradiated or not depends on individual patient and subject to review of each patient's clinical presentation and review of pathology and details of surgical procedure including whether the patient had undergone sentinel lymph node biopsy or a full axillary dissection and many other factors including biological markers defining level of aggression of the disease, etc. One size does not fit all and multidisciplinary conferences are where medical teams discuss the best approach for each patient and offer individualized care.
New answer by NoushinHartMD (Physician - Oncology - Radiation (Verified)) in topic(s) Radiation Therapy, Breast Cancer Radiation Treatment Options, Breast Cancer Radiation Treatment Sites, Breast Cancer, Radiation, Breast Cancer Radiation Therapy, Radiation Treatment Options, Radiation Treatment, Radiation Oncology, Post Mastectomy Treatments, Post Mastectomy
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11 months ago
NoushinHartMD (Physician - Oncology - Radiation (Verified)) asked the question in topic(s) Radiation Therapy, Breast Cancer Radiation Treatment Options, Breast Cancer Radiation Treatment Sites, Breast Cancer, Radiation, Breast Cancer Radiation Therapy, Radiation Treatment Options, Radiation Treatment, Radiation Oncology, Post Mastectomy Treatments, Post Mastectomy
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11 months ago
Long-term side effects of radiation for endometrial cancer are generally due to radiation to the other organs inside the pelvis. These include the bowel, the bladder, and the vagina.
Radiation to the bowel can cause chronic diarrhea, bowel obstruction and fistula formation. A fistula is an abnormal connection or passageway between two organs that normally do not connect and requires surgical repair. Radiation to the bowel may also cause thinning of the blood vessels in the bowel which may cause bleeding even with the normal passage of the stool. This may require laser ablation to stop the bleeding.
Radiation to the bladder can cause stiffening of the bladder and therefore frequency of urination. Internal and/or external radiation to the vagina can cause narrowing of the vagina which would be progressive and would only be prevented by using a vaginal dilator. This is usually provided by the radiation oncologist after completion of radiation treatments.
Even though statistically the risk is relatively small, radiation would increase the risk of a secondary malignancy in the irradiated field. Therefore the above mentioned organs are potentially at risk of developing another cancer. Particularly in case of endometrial cancer one has to be aware of HNPCC or Hereditary nonpolyposis colorectal cancer. This is a syndrome with increased risk of colorectal and endometrial cancer but unfortunately two major factors in this syndrome are overlooked even by medical professionals. One is the fact that individuals affected by this syndrome do not have increased number of polyps in their colon or rectum. The second one is the fact that women with HNPCC are at higher risk for endometrial cancer that they are for colorectal cancer. Therefore often when a woman is diagnosed with endometrial cancer nobody is alarmed about their risk of colorectal cancer regardless of whether they get radiation therapy or not and they should be!
Radiation to the bowel can cause chronic diarrhea, bowel obstruction and fistula formation. A fistula is an abnormal connection or passageway between two organs that normally do not connect and requires surgical repair. Radiation to the bowel may also cause thinning of the blood vessels in the bowel which may cause bleeding even with the normal passage of the stool. This may require laser ablation to stop the bleeding.
Radiation to the bladder can cause stiffening of the bladder and therefore frequency of urination. Internal and/or external radiation to the vagina can cause narrowing of the vagina which would be progressive and would only be prevented by using a vaginal dilator. This is usually provided by the radiation oncologist after completion of radiation treatments.
Even though statistically the risk is relatively small, radiation would increase the risk of a secondary malignancy in the irradiated field. Therefore the above mentioned organs are potentially at risk of developing another cancer. Particularly in case of endometrial cancer one has to be aware of HNPCC or Hereditary nonpolyposis colorectal cancer. This is a syndrome with increased risk of colorectal and endometrial cancer but unfortunately two major factors in this syndrome are overlooked even by medical professionals. One is the fact that individuals affected by this syndrome do not have increased number of polyps in their colon or rectum. The second one is the fact that women with HNPCC are at higher risk for endometrial cancer that they are for colorectal cancer. Therefore often when a woman is diagnosed with endometrial cancer nobody is alarmed about their risk of colorectal cancer regardless of whether they get radiation therapy or not and they should be!
New answer by NoushinHartMD (Physician - Oncology - Radiation (Verified)) in topic(s) Endometrial Cancer Treatment Side Effects, Endometrial Cancer What To Expect, Long Term Side Effects, Radiation Therapy What To Expect, Radiation Treatment What To Expect, What To Expect, Radiation Side Effects, Radiation Therapy, Radiation Treatment Side Effects, Radiation Therapy Side Effects, Radiation Treatment, Side Effects, Endometrial Cancer
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11 months ago
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