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Robert Lustig, MD
RobertLustigMD (Physician - Oncology - Radiation (Verified) )| Communities: Oral Cavity and Pharynx Cancer | Answers: 8 |
| Member Since: May. 2012 |
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Professional Statement
Dr. Lustig is Professor of Clinical Radiation Oncology at the University of Pennsylvania School of Medicine.
Dr Lustig graduated from Franklin and Marshall College in Lancaster PA and then completed medical school at Jefferson Medical College. He completed 2 years of internal medicine training at New York Medical College followed by 2 years in the United States Navy. He returned to Philadelphia and completed his residency at Thomas Jefferson University Hospital. He practiced radiation oncology at Cooper Hospital/University Medical Center in Camden New Jersey and was on the faculty of the University of Medicine and Dentistry of New Jersey. He came to the University of Pennsylvania in 1998 and specialized in the treatment of brain tumors and head and neck cancer. He was appointed a Fellow of the American College of Radiology and has been co-chairman of the Quality Control Committee of the Radiation Therapy Oncology group which is a national organization developing and managing clinical trials in radiation therapy. He is a member of the board of the Pediatric Proton Foundation.
Dr Lustig graduated from Franklin and Marshall College in Lancaster PA and then completed medical school at Jefferson Medical College. He completed 2 years of internal medicine training at New York Medical College followed by 2 years in the United States Navy. He returned to Philadelphia and completed his residency at Thomas Jefferson University Hospital. He practiced radiation oncology at Cooper Hospital/University Medical Center in Camden New Jersey and was on the faculty of the University of Medicine and Dentistry of New Jersey. He came to the University of Pennsylvania in 1998 and specialized in the treatment of brain tumors and head and neck cancer. He was appointed a Fellow of the American College of Radiology and has been co-chairman of the Quality Control Committee of the Radiation Therapy Oncology group which is a national organization developing and managing clinical trials in radiation therapy. He is a member of the board of the Pediatric Proton Foundation.
Professional Info
Credential: MD
Primary specialty: Oncology - Radiation
Medical school: Thomas Jefferson Medical College
Residency: New York Medical College
Internship: New York Medical College
Areas of expertise: Tumors of the CNS, head and neck cancer
Research interests: Photodynamic therapy; oxygen transport systems; radiation sensitizers
Hospital affiliation: Penn Medicine
Practice name: Perelman Center for Advanced Medicine
Practice address:
3400 Civic Center Boulevard
Philadelphia, PA
19104
Practice phone number: 1-800-789-PENN (7366)
RobertLustigMD Activities
The recurrence rate depends on the size of the lesion treated and the dose delivered. Larger lesions are more likely to reoccur over time. To evaluate recurrence rate a time point needs to be specified, i.e. 6 months, 12 months, etc.
New answer by RobertLustigMD (Physician - Oncology - Radiation (Verified)) in topic(s) Brain Tumor Recurrence, Minimally Invasive Brain Surgery, Radiation, Gamma Knife Radiosurgery, Gamma Knife Radiosurgery Side Effects, Recurrence Rate, Radiation Treatment Side Effects, Stereotactic Radiosurgery Side Effects, Radiation Therapy Side Effects, Minimally Invasive Surgery, Stereotactic Radiosurgery, Metastatic Breast Cancer, Brain Tumor Recurrence Rate, Radiation Treatment, Brain Cancer Radiation Oncology, Breast Cancer Brain Metastasis, Radiation Oncology, Surgery
1
Answer |
10 months ago
This type of MRI is performed after injection of twice the standard amount of contrast dye and then performing the MRI with very thin sections. Each section is usually 1.0 to 1.5mm thick. This gives many more MRI slices to evaluate and decreases the risk of missing very small lesions. It is generally employed in the treatment planning for stereotactic (focused beams) radiation for metastatic disease.
New answer by RobertLustigMD (Physician - Oncology - Radiation (Verified))
1
Answer |
10 months ago
This most commonly occurs with metastatic tumors. These are tumors that arise somewhere else in the body and then spread to the brain. Many of the decisions regarding treatment of brain metastasis depend on the type of primary tumor and the extent of tumor in other parts of the body. If there is a single lesion in the brain this may be approached by surgery followed by radiation or stereotactic radiation (focused beams to a small area ) using a variety of equipment (Gamma Knife, Cyberknife, Linac). Stereotactic radiation may be used for up to 4-6 lesions and then observed. Whole brain radiation is often used when there are many brain lesions, when the patient is in poor condition, or possibly following stereotactic therapy.
New answer by RobertLustigMD (Physician - Oncology - Radiation (Verified))
1
Answer |
10 months ago
The main factors include:
1. Histology of the tumor. Was it benign or malignant? If it was malignant what was the grade. Brain tumors are graded I through IV with IV the most aggressive.
2. Molecular markers. Some tumors have molecular markers that can help assess how aggressive the tumor is.
3. Was the tumor completely removed?
4. Age of the patient. Some low grade tumors in young people may be watched to determine if there is further growth and thus delay radiation.
1. Histology of the tumor. Was it benign or malignant? If it was malignant what was the grade. Brain tumors are graded I through IV with IV the most aggressive.
2. Molecular markers. Some tumors have molecular markers that can help assess how aggressive the tumor is.
3. Was the tumor completely removed?
4. Age of the patient. Some low grade tumors in young people may be watched to determine if there is further growth and thus delay radiation.
New answer by RobertLustigMD (Physician - Oncology - Radiation (Verified))
1
Answer |
10 months ago
Most patients see a radiation oncologist after surgery when a diagnosis has been established. This may be following a biopsy or resection of the tumor. There are some tumors where surgery may be contraindicated due to the location of the tumor and the patient should be seen after radiologic diagnosis.
New answer by RobertLustigMD (Physician - Oncology - Radiation (Verified))
1
Answer |
10 months ago
The radiation oncologist will want to start with some basic information. It is best to have this written down as it makes it less likely that you will forget some.
1. A copy of the prior medical records
2. A CD with copies of all MRIs
3. A copy of the pathology report and the actual slides for review
4. List of all medications
5. List of allergies
6. List of all prior medical conditions
7. List of all prior surgeries.
8. Any diseases that tend to run in the family
9. An outline of all symptoms and complaints prior to diagnosis
10. An outline of current medical problems and complaints
1. A copy of the prior medical records
2. A CD with copies of all MRIs
3. A copy of the pathology report and the actual slides for review
4. List of all medications
5. List of allergies
6. List of all prior medical conditions
7. List of all prior surgeries.
8. Any diseases that tend to run in the family
9. An outline of all symptoms and complaints prior to diagnosis
10. An outline of current medical problems and complaints
New answer by RobertLustigMD (Physician - Oncology - Radiation (Verified))
1
Answer |
10 months ago
There are a number of pieces of equipment that can deliver external radiation. The most common piece is a linear accelerator. This machine delivers x ray beams of 6MV(low energy) or 10-18MV(high energy). There are a number of treatment planning methods to deliver x rays. The simplest is 3 D conformal. Usually 2 to 4 beams are used and the entire target is treated by each beam. The fields can be shaped using the multileaf collimator which is attached to the machine head or by lead blocks which can be constructed and attached to the machine. IMRT (intensity modulated radiation therapy) is a more complex treatment plan. In additional to designating targets to be treated, targets to be avoided are contoured. Dose limits are then given for these organs. In IMRT 5 to 9 treatment fields are used. However, some fields may treat only a part of the tumor or the leaves on the collimator may move during treatment to differentially dose the target. Rapid arc is the use of the rotating gantry head and the simultaneous motion of the collimator leaves to shape the field. Brain tumors are generally treated daily for 6 to 7 weeks.
Gamma Knife uses 201 fixed Cobalt60 sources all aimed at a central point. These can be adjusted for size using collimators with openings as small as 0.4cm. The patient’s head is fixed in a frame and adjusted in the machine to focus the beams at the target. Usually multiple “shots” are given to the target. The treatment is given in one session.
The Cyberknife is a small 6MV linear accelerator mounted on a robotic arm. The machine also has built in x rays to track the position of the head. The radiation can be delivered through multiple non-coplanar angles and has the ability to shape the treatment to fit the tumor. Generally one to five treatments are used with a higher dose per treatment then standard therapy.
Protons are generated from a cyclotron. Protons are particles and only go a finite distance before disintegrating and depositing their energy. Protons can be delivered from a fixed beam or from a rotating gantry. The depth of treatment can be adjusted by manipulating the beam after it leaves the cyclotron. The advantage of protons is protection of normal brain tissue.
Gamma Knife uses 201 fixed Cobalt60 sources all aimed at a central point. These can be adjusted for size using collimators with openings as small as 0.4cm. The patient’s head is fixed in a frame and adjusted in the machine to focus the beams at the target. Usually multiple “shots” are given to the target. The treatment is given in one session.
The Cyberknife is a small 6MV linear accelerator mounted on a robotic arm. The machine also has built in x rays to track the position of the head. The radiation can be delivered through multiple non-coplanar angles and has the ability to shape the treatment to fit the tumor. Generally one to five treatments are used with a higher dose per treatment then standard therapy.
Protons are generated from a cyclotron. Protons are particles and only go a finite distance before disintegrating and depositing their energy. Protons can be delivered from a fixed beam or from a rotating gantry. The depth of treatment can be adjusted by manipulating the beam after it leaves the cyclotron. The advantage of protons is protection of normal brain tissue.
New answer by RobertLustigMD (Physician - Oncology - Radiation (Verified))
1
Answer |
11 months ago
In most cases of tumors in the brain surgery is done to both establish a diagnosis and remove the tumor. There are some cases in which surgery carries a very high risk of complications and radiation may be delivered based on the MRI findings which are characteristic for a specific tumors. Some examples are meningiomas involving a cranial nerve or the brain stem or acoustic neuromas which involve the nerve for hearing.
New answer by RobertLustigMD (Physician - Oncology - Radiation (Verified))
1
Answer |
11 months ago
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