Sophia Edwards Bennett

Dear Patient,

Indeed, change in skin color/skin discoloration is one of the most common side effects of radiation therapy. This side effect, similar to a "sunburn," is observed with external beam radiation therapy; because the skin which is sensitive to radiation, is the first ‘point of contact’ in the path of the radiation beam as it traverses to the site of the target lesion. The red skin discoloration you described on your leg is referred to, in medical terms as erythema, defined as "redness of the skin." Erythema is the initial skin reaction induced by radiation treatment, after which skin desquamation (skin peeling) may ensue. We usually encourage the application of a topical moisturizing cream, approved by your physician, to the treated area 1-2 times per day at an interval of greater than 2-4 hours prior to, or after, each daily treatment. Should your skin reaction progress to skin peeling, your Oncology team will likely prescribe a topical agent called Silvadene, if you do not report an allergy to sulfa-containing agents. Other topical interventions or concoctions can be recommended for patients who are allergic to sulfa drugs. It is important and reassuring to note that radiation-induced skin reaction will resolve after completing the course of radiation. The interval required, and the rate of resolution of skin toxicity varies between patients.
I do hope that the explanation herein amply addresses your question.

Regards,

Dr. EB

Dear Concerned Cousin,

Thank you for sharing your questions regarding the recommended course of radiation therapy for your cousin. Indeed, radiation therapy is associated with multiple side effects. This is particularly pertinent in the pediatric population, as radiation in younger patients can result in growth abnormalities, compromised reproductivity/fertility, endocrine dysfunctions (resulting in hormone deficiencies) and future secondary malignancies (a.k.a. radiation-induced cancers). Please note that, regardless of age, radiation is local treatment and, as such, the side effects are almost exclusively localized to the treatment/target site. However, despite its acute and long-term side effects, radiation therapy is essential and highly effective in the treatment of most childhood malignancies, either in unimodality, or as a component of multimodal treatment. Thus, the risks and benefits of radiation, weighed meticulously, must be thoroughly explained to parents/guardians and, of course, the patient. Pediatric oncology protocol review, treatment delivery, and interim and post-treatment evaluations are methodically planned and systematically executed. Notably, side effects are closely monitored and preempted for early intervention, and to avert treatment-related events.

For all the aforementioned reasons, pediatric cancer patients are routinely referred to large multidisciplinary cancer institutions, equipped with the required resources, specialized skills and experience, to render optimal care for pediatric cancer patients (like your cousin).
I hope that the explanation herein sufficiently addresses your concerns.

Best regards,

Dr. EB

Radioimmunotherapy is a combination of radiation and Immunotherapy. The rationale for this coupling is to utilize an antibody labeled with the radioactive source/treatment to execute targeted delivery of radiation therapy to the disease site. Given the higher specificity of the treatment, the side effects are generally less pronounced than chemotherapy. The most common side effects of radioimmunotherapy include decrease in blood counts, i.e., white blood cells, red blood cells, platelets etc., resulting in possible infections accompanied by fever and chills, anemia, bleeding. Other side effects include gastrointestinal symptoms such as nausea, vomiting, and diarrhea. Skin rashes can also occur and are usually diffuse but not pruritic in nature. It should be noted that, as with any agent administered, there is a risk of an allergic reaction. Prior to the initiation of treatment, your friend's radiation oncologist should provide a detailed explanation of the course of treatment, duration, and side effects.
I hope that the explanation herein will be helpful in both informing and prompting important discussions to enter with your friend’s radiation oncology team.

Best regards,

Dr. EB

Dear patient,

The timing/onset of radiation side effects varies between patients. However, there are general temporal ranges that we can usually ascribe to the more common side effects. For example, during radiation therapy for breast cancer, a skin reaction is common, known in medical terms as radiation dermatitis. There are certain grades or levels of radiation dermatitis, or descriptive terminologies such as mild, moderate or severe. The initial skin reaction is redness (referred to as erythema in medical terms), possible itching (pruritus) or folliculitis (inflammation of follicles). This usually occurs within the second week of treatment and may be brisk at the end of the third week of the treatment course. The skin reaction may or may not progress to skin desquamation (skin peeling), as this is dependent on several factors including skin type, breast volume, treatment modality or technique, dose and fractionation (the dose per treatment and the total number of treatments).

A sense of "hardness" in the breast, which patients may perceive as a lump, actually represents scar tissue inside the breast as a result of surgery. This is most commonly present in the area of the lumpectomy scar, specifically in the case of breast conservation surgery (during which only the tumor is removed and the breast is preserved). This "sense of hardness"/scar tissue may increase with radiation. However, this should improve/soften over time post-treatment.

Another common side effect is fatigue. This is the only side effect not limited to the treatment site (the breast). Fatigue is usually mild-moderate, and is usually detected between the second (2nd) and third (3rd) week of treatment. Fatigue is cumulative, that is, it increases as treatment progresses. However, the level of fatigue experienced during the treatment of breast cancer does not usually affect your activities of daily living. Most patients maintain work and home activities throughout their entire treatment course. However, somnolence (feeling sleepy) may occur prematurely, such that you may need to retire to bed 1-2 hours earlier, in comparison to your usual pre-treatment sleep patterns. In addition, on weekend days, when you are not receiving radiation, you may require an afternoon nap per weekend day. It should be noted that patients who received chemotherapy before radiation, tend to develop and experience more fatigue than patients who did not undergo systemic treatment. This phenomenon is due to the cumulative effects of both treatment modalities (chemotherapy and radiation).
I hope that your questions and concerns have been adequately addressed.

Sincerely,

Dr. EB

There are several reasons for the recommendation of radiation therapy to the bone.In most cases, radiation therapy is recommended to bone if the primary cancer has spread to the bone, which is commonly associated with pain. In that scenario, radiation is being rendered palliatively, i.e., with the goal of relieving pain. Radiation therapy has been shown by multiple studies to be very effective in alleviating bone pain in this (the palliative) setting. The side effects of radiation therapy to the bone vary depending on the location (anatomically) of the bone receiving radiation. Generally, radiation can cause some level of fatigue. If the pelvic bone (which harbors bone marrow reserves) is the site of treatment, blood counts can decrease and should therefore be monitored throughout the course of treatment, especially if chemotherapy preceded or is being administered concurrently with radiation.Radiation can also cause bone damage although this is not as common; and again, depends on the site receiving radiation, the pre-radiation status of the bone, prior anti-cancer treatments, and the dose of radiation prescribed. Other side effects of radiation can occur depending on the organs close to the bone being treated. For example, radiation of bones located in the abdomen or the pelvis can cause diarrhea due to bowel in the radiation field. I would advise you to discuss with your radiation oncology team, the specific side effects associated with the bone for which radiation therapy is being recommended.

Regards,

Dr. EB

A radiation oncologist can certainly evaluate whether or not radiation is indicated for cancer in the liver.However, there are several treatment modalities than can be applied to treat cancer in the liver. These are- generally-surgery, chemotherapy (via different routes of administration) or radiation therapy. The most appropriate mode of treatment will depend on the type (histology) of cancer, the stage (primary of metastatic from another site), and/or the number of lesions in the liver.Some centers may engage in a multidisciplinary team discussion, often referred to as a tumor board, to devise the best treatment algorithm. I would advise you to enter further discussion with your primary oncologist for additional direction, and to determine the most clinically appropriate treatment. 

Best regards,

Dr. EB 

Dear Patient/Patient Advocate,

You have posed a very interesting question. However, the answer is quite complex, as detailed information regarding the cancer in question would need to be ascertained and thoroughly reviewed, prior to rendering a definitive response.

I can clearly state however, that in general, for most cancers, our treatment algorithm very rarely offers the choice between radiation versus/or chemotherapy.

The answer lies in the following explanation:

There are three main types of treatment modalities that can be employed to treat cancer.

These are namely :

1) Surgery

2) Systemic treatments such as chemotherapy, hormonal or immunotherapy and

3) Radiation Therapy

Surgery is considered local treatment- but is invasive, as it involves the excision/removal of the tumor from the body, either partially or completely.

Chemotherapy and other types of systemic treatment, by nature of the route of administration (by mouth or intravenously (via the veins) , are not local, but are diffusely distributed throughout the body, except for sites that are considered impermeable to most systemic agents, such as the blood-brain barrier.

Radiation therapy, specifically EBRT (external beam radiation therapy) is, like surgery, also considered local treatment. However, unlike surgery, external beam radiation therapy is non-invasive.

The type(s) or modality (modalities) of treatment(s) recommended for cancer is/are determined by the cancer histology/ the type of cancer.

For example, in the case of breast cancer, surgery is usually recommended, and is therefore the mainstay treatment for breast cancer. However, other factors determine whether or not chemotherapy and/or radiation therapy should be prescribed. These factors include, but are not limited to: the stage of the cancer, status of surgical margins (some or all tumor removed), and expression of certain receptors (estrogen, progesterone, human epidermal growth factor 2); as well as the age of the patient, patient performance status, and the presence of other medical comorbidities such as heart disease.

So, in conclusion, although not all treatment modalities are necessary for all cancers, the decision regarding the type (s) of treatment applied to any cancer diagnosis is dictated by the standard of care for the specific cancer in question. As noted above, several other factors may also influence the final course of treatment.

I hope the details presented above adequately address your question.

Sincerely,

Dr. EB

Dear Patient,

Thank you for your interesting question.
Radiation therapy is utilized in the treatment of most cancers, and in general is very effective. However, it’s efficacy, application and timing is dependent upon the specific type of cancer; and may require, and work in conjunction with, other treatment interventions such as surgery, chemotherapy and other systemic agents such as hormone receptor targeted therapy (e.g., in the case of breast cancer). In addition, certain cancers may require a higher dose of radiation than others, or a different regimen and duration of radiation therapy. To address the question of the indications/criteria for radiation:

As stated above, radiation therapy is used to treat most cancers. Factors such as age, tumor histology (the type of cancer), tumor size, spread to lymph nodes, spread to bone, brain or other organs, symptom profile (e.g., pain) due to the disease, cancer stage, surgical margin status (positive or negative); all determine the indications/application/criteria for radiation therapy. These factors have been identified by multiple studies which have been published elucidating the effect of radiation (with or without other therapeutic interventions).

Congratulations on your expected new addition to the family. Mammograms emit very low radiation, which is directed at the breast and not in the area of the fetus-in the uterus. Thus it is generally safe to undergo mammogram, which is usually only required once yearly.

Regards,

SEB

Dear Patient,

If you are inquiring about the duration of the entire course of recommended radiation treatment, the number of fractions (treatments) prescribed by your physician (radiation oncologist) is determined by the type of cancer, as well as the site (part) of the body involved with cancer (example, breast, lung, etc.). If your question specifically refers to the time required for each radiation treatment — the dose of radiation prescribed, the treatment technique and the type of radiation machine being utilized, will all dictate the treatment time per fraction. However, typically, each daily treatment will be delivered in approximately 7-10 minutes. I do inform my patients that although treatment delivery time is 7-10 minutes, accurate patient positioning must be verified prior to each daily treatment. Thus, the total time "on the treatment table" is approximately 10-15 minutes.
Hopefully, the explanation above has adequately addressed your question.

Regards,

Dr. EB

Dear Concerned Patient,

It is normal to experience hyper-pigmentation (darkening) of the skin during the course of radiation. We usually detect skin hyper-pigmentation during breast radiation, after 1-2 weeks of radiation treatment. However, this timeline varies and is dependent on several factors, including skin type. I would recommend entering a discussion with your oncologist about skin moisturizing creams that can be applied during treatment.

Best regards,

Dr. EB

Fatigue is one of the most common side effects of chemotherapy, and cancer treatment in general. Thus, during treatment, adequate rest is recommended. Nutritional supplements such as vitamin B12 help to boost energy. I recommend that your wife discuss the addition of this supplement with her medical oncologist.

Best regards,

Dr. EB

Loss of appetite can occur during radiation. It is more commonly observed as an indirect result of radiation to gastrointestinal sites, such as the stomach and bowel, which  induces side effects such as nausea, vomiting, and diarrhea.

Regards,
Dr. EB

Dear Patient,
I would recommend that you seek consultation with your primary care physician for thorough evaluation. Your physician will complete a physical examination, and recommend referral for a biopsy if deemed warranted. This (a biopsy) would be necessary to determine if the lymph nodes are malignant (cancerous) or benign (noncancerous). The appropriate treatment would be recommended if the node is malignant. If treatment includes surgery, this procedure will excise/remove the cancer, and is not associated with any risk of spread. If the lymph node is benign, usually surgery is not indicated, unless associated with symptoms warranting such intervention.
Thank you for entrusting me with your clinical concerns.
Sincerely,
Dr. EB

Response to your question regarding moles:
If the color and/or shape of your mole changes, further evaluation by a dermatologist is recommended. Your dermatologist will perform a thorough examination and determine the appropriate intervention.

Regards,
Dr. EB

Thank you for allowing me to participate in your father's care.Per your inquiry, your father is a 75 year old male who has been diagnosed with prostate cancer, after presenting with a PSA of 7.2.However, in order to offer specific treatment recommendations, I would need to know the results from your father's biopsy. The biopsy results will inform me of the Gleason Score, which is essentially the 'grade' of the prostate cancer.The Gleason score and the PSA are the main factors that determine treatment recommendations, and would therefore guide your father's treatment decisions.The seeds that you mentioned are radioactive (iodine -125) seeds that are implanted in the prostate, by a procedure known as brachytherapy. These seeds are implanted to kill cancer cells. The implantation requires an outpatient surgical procedure during which your father would be under anesthesia, so that he does not experience any pain throughout the procedure.An expert radiation oncologist implants the radioactive seeds under the guidance of ultrasound imaging to ensure that the seeds are placed accurately.The procedure described is usually completed in approximately 1.5 hours (90 minutes).Should your father decide to proceed with radiative seed implantation, his Radiation Oncologist would provide him with detailed instructions about how to prepare for the procedure, what to expect after the procedure, as well as follow-up care.Best Regards,Sophia Edwards-Bennett MD PHD(Dr. EB)