Radiation Oncology   

If further resection is possible, would you recommend adjuvant radiation? Would you consider definitive radiation alone? Would you recommend convent...

Specifically, headaches thought not to be related to increased ICP.

E.g., patients with small CNS mets without vasogenic edema or symptoms. Epidural disease without epidural spinal cord compression or asymptomatic low-...

If so, how long do you continue medication and when do you discontinue? Does treatment with surgical resection versus radiation alone change your mana...

Do you treat this similarly to IDH-Wildtype GBM with the STUPP regimen? Is there any role of less-intensive paradigms, such as 59.4 Gy/33 fx?

Is there a role for adjuvant chemotherapy or radiation?

If so, how long would you hold? This medication is given for migraines as q3 month infusions and some data suggest that CGRP plays a role in immune-mo...

Do you recommend adjuvant chemotherapy after radiation treatment?

With the recent publication in IJROBP showing a greater than 50% response rate, have you started integrating this into your practice? 

Do you ever allow patients to receive a couple of cycles of systemic therapy first if there is high burden of disease? What is the maximum time after ...

What is the harm of waiting for another recurrence after a second GTR to delay the toxicity of radiation and chemotherapy? The patient is a woman <...

In a patient with metastatic cancer to the lumbar spine and epidural disease on CT who presents back pain and leg weakness: Is a whole spine MRI in...

Do all patients with brain metastases get started on anticonvulsants?  Do you decide based on extent of edema, tumor size, or something else?&nb...

What workup do you typically recommend?

Is there diminished radiotherapy efficacy in tumor control after certain timeframe has passed for malignant meningiomas with no signs of recurrent dis...

For example a 1 or 2 mm brain metastasis? Would you consider waiting for these to enlarge slightly for reasons such as more certainty they are real, l...

How does this strategy change depending on the acuity or chronicity of the symptoms?

If a patient has a metastatic lesion in close proximity to one hippocampus, would you offer sparing of the contralateral hippocampus? Do your dose con...

Is your approach different than that to a primary essential tremor?

History of 4th ventricle choroid plexus papilloma s/p GTR, now with recurrent disease in the 4th ventricle and the left lateral ventricle (7 nodules i...

How does 1p/19q co-deletion and IDH mutation status influence your decision? 

When do you consider observation? 

Would you consider empiric SRS if biopsy/resection is not feasible? When would you consider liquid biopsy?

What is your preferred dose/fractionation following a previous course of radiotherapy?

Assouline et al., PMID 24411632 recommend delivering 500cGy x 4 fractions = 2000cGy on days 1, 3, 8, 10. Do you follow this schedule, treat every othe...

 If not, then what is your preferred treatment and would you integrate SRS into it? 

Do you ever add prophylactic Keppra (levetiracetam) for glioblastoma patients without a seizure history based on data such as this study (nature.com) ...

How often are you scanning the brain and what is your trigger to treat?

If so, what percent likelihood do you quote patients for this risk with SRS, SRT and fully fractionated therapy?

Do you routinely discontinue the device or continue if they are otherwise tolerating the treatment well? 

Do you require neurosurgical evaluation first? Do you require any patients to wear a neck brace?  

What would be your preferred technique and dose/fractionation?

For stroke-like migraine attacks after radiation therapy (SMART syndrome), does your management of these patient's change with recurrent episodes? How...

If so, when do you consider this? 

Is there any additional benefit to radiation in addition to steroids in a patient who is not a surgical candidate?

Has the recently published interim analysis of the CATNON trial altered your utilization of temozolomide?Does IDH status change your treatment approac...

Do you consider the small, but statistically significant, improvement in OS to outweigh the side effects of treatment?

Length of temozolomide course when given with adjuvant radiotherapy

What factors play into your decision whether to re-treat the brain with craniospinal radiotherapy vs irradiation of the spine only vs other measures (...

E.g. The case in question is for a patient planned for thoracic RT for LS-SCLC. Any medications that may help or just give much bigger expansions to c...

When do you favor RT? What is your preferred dose/fractionation?

How does length of time from prior chemoradiotherapy influence your management?

In a palliative setting, how long would you wait to initiate WBRT?