Palliation

Thoracic Malignancies

Questions discussed in this category

Is it acceptable to treat newly diagnosed small cell lung cancer with limited brain metastasis with upfront SRS?

This has become standard practice at our institution for patients with a good performance status, with whole brain radiotherapy given after the comple...

12 Answers available

How would you treat a patient with oligometastatic disease to the lung for whom SBRT/SABR is not feasible?

How would you approach treatment if SBRT was not technically possible? How would you opt to treat if SBRT was instead not covered by insurance, and w...

2 Answers available

Do you recommend holding a TKI when treating brain metastases with SRS/WBRT?

Is there evidence that supports/refutes the safety of concurrent use?

1 Answer available

What is a safe and effective ablative dose and fractionation for oligometastasis to humeral head or femoral neck from lung cancer with controlled disease elsewhere?

1 Answer available

How do you approach the treatment of patients with widespread ES-SCLC with a poor performance status?

How do you decide between supportive care v. chemoimmunotherapy? Is there a threshold of disease burden that would push you towards recommending hospi...

4 Answers available

What is the best treatment dose and fractionation for WBRT in a patient who has numerous brain mets and previously received PCI with 25Gy/10fx for small cell lung cancer?

1 Answer available

How would you approach the treatment of isolated lesions within the spleen for a patient with metastatic small cell lung cancer and well-controlled disease elsewhere after chemotherapy?

Would you offer SABR in the setting of only two lesions? How would your recommendation change if this was NSCLC?

2 Answers available

How would you approach a symptomatic patient with with a history of whole brain RT with new bilateral MRI enhancing lesions within the optic nerves?

Would you suspect progressive disease v. radiation necrosis vs optic neuritis due to immunotherapy. Eyes were within radiation field 8 months ago.&nbs...

1 Answer available

Would you offer palliative radiation therapy for bleeding risk reduction in a patient with large vessel invasion from an intrathoracic tumor who requires anticoagulation?

Would tumor pathology affect your decision-making (e.g. angiosarcoma)?

1 Answer available

Is it safe to deliver SBRT to progressive lung metastases to patients with metastatic RCC receiving concurrent pazopanib?

2 Answers available

Do you have a size criteria when treating lung oligometastases with SBRT?

Would you consider treating 3-5mm lesions with SBRT or wait until they are a certain size? I am concerned I will not be able to see them adequately on...

4 Answers available

Should local consolidative therapy be offered to patients with oligometastatic NSCLC who do not progress after induction systemic therapy?

Is this recommended in a certain subset of patients (EGFR positive or 1 metastasis only)? Or should we await maturation of the MD Anderson/Colorado/On...

5 Answers available

Is it acceptable to treat patients with limited, asymptomatic brain metastases and EGFR-mutant NSCLC with upfront TKI?

Can SRS or whole brain radiotherapy be reserved for progression in these young, healthy patients?

8 Answers available

How would you manage palliation in a patient with postobstructive pneumonia caused by a mediastinal mass?

Would you treat if there is active infection? How much improvement would you expect?

1 Answer available

When would you consider using radiation for cardiac metastases?

Would you treat if the patient is asymptomatic? If you do treat with RT, what dose-fractionation would you use, and what volumes do you target?

1 Answer available

When is it appropriate to recommend SBRT directed to sites of oligometastasis (ex, single adrenal met) for a patient with extensive stage small cell s/p chemo and PCI?

3 Answers available

Is it safe and appropriate to palliatively treat abdominal or thoracic tumors with concurrent chemotherapy when using fractions of 250-300 cGy?

For example, there is a retrospective series out of MD Anderson (Kim, Acta Oncologica 2008) wherein 37 patients with gastric cancer were treated with ...

2 Answers available

Would you utilize SRS/SBRT in a patient with oligometastatic disease from adenocarcinoma of the lung who is unable to receive standard chemotherapy?

For example, in a patient minimal brain and liver metastasis, would you treat all sites definitively?

2 Answers available

When giving palliative lung radiation to a patient on immune checkpoint blockade for NSCLC, do you hold immunotherapy?

If not what radiation fractionation regimen is preferred for otherwise good KPS patient?

1 Answer available

Do you require a biopsy prior to SBRT for pulmonary metastases from oligometastatic disease?

Specifically from a GI primary?

3 Answers available

Is it safe to give thoracic irradiation to a patient with lung cancer previously treated with a VEGF inhibitor?

I've read about patients who were treated with concurrent bevacizumab-RT who developed lethal tracheoesophageal fistulas. How long would you have to w...

1 Answer available

When is it appropriate to use SBRT in treating lung metastases (oligomet, up to 3 mets etc.?)

What dose/fractionation is appropriate and does it differ between histology?

1 Answer available

Papers discussed in this category

International journal of radiation oncology, biology, physics, 2013-09-01

Increased bowel toxicity in patients treated with a vascular endothelial growth factor inhibitor (VEGFI) after stereotactic body radiation therapy (SBRT).

Clinical oncology (Royal College of Radiologists (Great Britain)), 2007-09

Value of whole brain re-irradiation for brain metastases--single centre experience.

Radiation oncology (London, England), 2014-01-03

Re-irradiation in the treatment of patients with cerebral metastases of solid tumors: retrospective analysis.

Radiother Oncol, 2011 Nov

Outcomes of stereotactic ablative radiotherapy following a clinical diagnosis of stage I NSCLC: comparison with a contemporaneous cohort with pathologically proven disease.

N Engl J Med, 2007 Aug 16

Prophylactic cranial irradiation in extensive small-cell lung cancer.

J Clin Oncol, 1999 Jul

Role of radiation therapy in the combined-modality treatment of patients with extensive disease small-cell lung cancer: A randomized study.

Lancet, 2015 Jan 3

Use of thoracic radiotherapy for extensive stage small-cell lung cancer: a phase 3 randomised controlled trial.

International journal of radiation oncology, biology, physics, 2011-11-01

Stereotactic radiosurgery for patients with brain metastases from small cell lung cancer.

Int. J. Radiat. Oncol. Biol. Phys., 2006-09-01

A pathology-based substrate for target definition in radiosurgery of brain metastases.

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2017-12

Prophylactic Cranial Irradiation (PCI) versus Active MRI Surveillance for Small Cell Lung Cancer: The Case for Equipoise.

Lancet Oncol., 2017-05-01

Prophylactic cranial irradiation versus observation in patients with extensive-disease small-cell lung cancer: a multicentre, randomised, open-label, phase 3 trial.

The New England journal of medicine, 1999-08-12

Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. Prophylactic Cranial Irradiation Overview Collaborative Group.

BMC Cancer, 2015-08-15

Management of brain metastasis with magnetic resonance imaging and stereotactic irradiation attenuated benefits of prophylactic cranial irradiation in patients with limited-stage small cell lung cancer.

Journal of cancer research and therapeutics, 2012

Clinical outcomes of reirradiation of brain metastases from small cell lung cancer with Cyberknife stereotactic radiosurgery.

International journal of radiation oncology, biology, physics, 2012-05-01

Gamma knife stereotactic radiosurgery as salvage therapy after failure of whole-brain radiotherapy in patients with small-cell lung cancer.

Neurosurgery, 2013-10

Tumor histology predicts patterns of failure and survival in patients with brain metastases from lung cancer treated with gamma knife radiosurgery.

Practical radiation oncology, 2015

Local recurrence and survival following stereotactic radiosurgery for brain metastases from small cell lung cancer.

J. Neurosurg., 2005-01-01

Radiosurgery for patients with recurrent small cell lung carcinoma metastatic to the brain: outcomes and prognostic factors.

J Korean Neurosurg Soc, 2011-08-01

The role of radiosurgery in patients with brain metastasis from small cell lung carcinoma.

Radiat Oncol, 2014-07-08

Upfront stereotactic radiosurgery in patients with brain metastases from small cell lung cancer: retrospective analysis of 41 patients.

BMC Cancer, 2015-03-04

Is stereotactic radiosurgery a rational treatment option for brain metastases from small cell lung cancer? A retrospective analysis of 70 consecutive patients.

Acta Neurochir (Wien), 2013-01-01

Efficacy and limitations of salvage gamma knife radiosurgery for brain metastases of small-cell lung cancer after whole-brain radiotherapy.

The Lancet. Oncology, 2009-11

Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2007-04-01

Regression after whole-brain radiation therapy for brain metastases correlates with survival and improved neurocognitive function.

J Clin Oncol, 2011 Jan 10

Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952-26001 study.

JAMA, 2016-07-26

Effect of Radiosurgery Alone vs Radiosurgery With Whole Brain Radiation Therapy on Cognitive Function in Patients With 1 to 3 Brain Metastases: A Randomized Clinical Trial.

Radiation oncology (London, England), 2014-09-30

Stereotactic radiosurgery alone for small cell lung cancer: a neurocognitive benefit?

Cancer, 2016-06-15

Risk of brain metastases in patients with nonmetastatic lung cancer: Analysis of the Metropolitan Detroit Surveillance, Epidemiology, and End Results (SEER) data.

J. Clin. Oncol., 2018 May 22

Prophylactic Cranial Irradiation Versus Observation in Radically Treated Stage III Non-Small-Cell Lung Cancer: A Randomized Phase III NVALT-11/DLCRG-02 Study.

Lung cancer (Amsterdam, Netherlands), 2018-06

Radiosurgery alone is associated with favorable outcomes for brain metastases from small-cell lung cancer.

The New England journal of medicine, 2018-08-23

Combined Nivolumab and Ipilimumab in Melanoma Metastatic to the Brain.

The New England journal of medicine, 2018-12-06

First-Line Atezolizumab plus Chemotherapy in Extensive-Stage Small-Cell Lung Cancer.

International journal of radiation oncology, biology, physics, 2019-04-01

Observe the Brain and Preserve the Mind.

Lancet, 2019 Oct 04

Durvalumab plus platinum-etoposide versus platinum-etoposide in first-line treatment of extensive-stage small-cell lung cancer (CASPIAN): a randomised, controlled, open-label, phase 3 trial.

JAMA oncology, 2019-06-01

Prophylactic Cranial Irradiation vs Observation in Patients With Locally Advanced Non-Small Cell Lung Cancer: A Long-term Update of the NRG Oncology/RTOG 0214 Phase 3 Randomized Clinical Trial.

International journal of radiation oncology, biology, physics, 2019-04-01

A Gray Zone Regarding Gray Matter.

International journal of radiation oncology, biology, physics, 2019-04-01

Small Cell Lung Cancer: PCI Uncertainty and Emerging Radiosurgery Interest.

Neurosurgery, 2019 Oct 10

Role of Gamma Knife Radiosurgery in Small Cell Lung Cancer: A Multi-Institutional Retrospective Study of the International Radiosurgery Research Foundation (IRRF).

JAMA Oncol, 2020 Jun 4

Evaluation of First-line Radiosurgery vs Whole-Brain Radiotherapy for Small Cell Lung Cancer Brain Metastases: The FIRE-SCLC Cohort Study.

J Clin Oncol, 2020 Aug 10

Radiosurgery for Small-Cell Brain Metastases: Challenging the Last Bastion of Preferential Whole-Brain Radiotherapy Delivery.

Lung Cancer, 2014 Aug 02

Metastatic sites and survival in lung cancer.

N Engl J Med,

The Effect of Advances in Lung-Cancer Treatment on Population Mortality.

Lancet Oncol, 2020 Apr 03

Pembrolizumab for management of patients with NSCLC and brain metastases: long-term results and biomarker analysis from a non-randomised, open-label, phase 2 trial.

Int J Radiat Oncol Biol Phys,

Neurocognitive outcome in brain metastases patients treated with accelerated-fractionation vs. accelerated-hyperfractionated radiotherapy: an analysis from Radiation Therapy Oncology Group Study 91-04.

JAMA,

Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial.

J Neurosurg,

Gamma knife radiosurgery for metastatic brain tumors from lung cancer: a comparison between small cell and non-small cell carcinoma.

Cancer,

Leptomeningeal metastases from small cell lung carcinoma.

Radiat Oncol, 2015 May 27

Radiotherapy for asymptomatic brain metastasis in epidermal growth factor receptor mutant non-small cell lung cancer without prior tyrosine kinase inhibitors treatment: a retrospective clinical study.

International journal of radiation oncology, biology, physics, 2016-06-01

Impact of Deferring Radiation Therapy in Patients With Epidermal Growth Factor Receptor-Mutant Non-Small Cell Lung Cancer Who Develop Brain Metastases.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017-04-01

Management of Brain Metastases in Tyrosine Kinase Inhibitor-Naïve Epidermal Growth Factor Receptor-Mutant Non-Small-Cell Lung Cancer: A Retrospective Multi-Institutional Analysis.

The New England journal of medicine, 2016-11-10

Pembrolizumab versus Chemotherapy for PD-L1-Positive Non-Small-Cell Lung Cancer.

The New England journal of medicine, 2018-01-11

Osimertinib in Untreated EGFR-Mutated Advanced Non-Small-Cell Lung Cancer.

N. Engl. J. Med.,

Osimertinib in EGFR Mutation–Positive Advanced NSCLC.

N Engl J Med, 2014 Mar 27

Ceritinib in ALK-rearranged non-small-cell lung cancer.

N Engl J Med, 2013 Jun 20

Crizotinib versus chemotherapy in advanced ALK-positive lung cancer.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2014-12-01

Phase II trial of stereotactic body radiation therapy combined with erlotinib for patients with limited but progressive metastatic non-small-cell lung cancer.

International journal of radiation oncology, biology, physics, 2016-06-01

Avoiding Severe Toxicity From Combined BRAF Inhibitor and Radiation Treatment: Consensus Guidelines from the Eastern Cooperative Oncology Group (ECOG).

Radiat Oncol, 2011-12-21

Radiotherapy and "new" drugs-new side effects?

The Lancet. Oncology, 2016-12

Local consolidative therapy versus maintenance therapy or observation for patients with oligometastatic non-small-cell lung cancer without progression after first-line systemic therapy: a multicentre, randomised, controlled, phase 2 study.

Clin Lung Cancer, 2011-11-01

Clinical outcomes of extensive stage small cell lung carcinoma patients treated with consolidative thoracic radiotherapy.

Lung cancer (Amsterdam, Netherlands), 1994-03

Toxicity of thoracic radiotherapy on pulmonary function in lung cancer.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2019-06-20

Local Consolidative Therapy Vs. Maintenance Therapy or Observation for Patients With Oligometastatic Non-Small-Cell Lung Cancer: Long-Term Results of a Multi-Institutional, Phase II, Randomized Study.

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2017-10

Randomized Phase II Study Comparing Prophylactic Cranial Irradiation Alone to Prophylactic Cranial Irradiation and Consolidative Extracranial Irradiation for Extensive-Disease Small Cell Lung Cancer (ED SCLC): NRG Oncology RTOG 0937.

Clinical orthopaedics and related research, 2010-10

In brief: classifications in brief: Mirels' classification: metastatic disease in long bones and impending pathologic fracture.

Radiother Oncol, 2018 Apr 26

Local control and fracture risk following stereotactic body radiation therapy for non-spine bone metastases.

Pract Radiat Oncol, 2020 Mar 11

Stereotactic Body Radiation Therapy for Nonspine Bone Metastases: International Practice Patterns to Guide Treatment Planning.

Lung Cancer, 2020 Sep 10

Patient-reported outcomes with first-line durvalumab plus platinum-etoposide versus platinum-etoposide in extensive-stage small-cell lung cancer (CASPIAN): a randomized, controlled, open-label, phase III study.

Palliation

Thoracic Malignancies

Questions discussed in this category

Papers discussed in this category

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