Radiation Oncology

Palliation

Questions discussed in this category

What dose/fractionation scheme would you employ for treatment of a bone with impending fracture prior to surgical fixation?

Would you use 30/10, 20/5, or 8/1, and why?

2 Answers available

What normal tissue dose constraints do you use when delivering up to 3 cycles of the palliative quad shot regimen for gynecologic pelvic malignancies?

1 Answer available

Does your choice of dose and fractionation for bone metastasis depend on the location of the metastasis in question?

What would you choose as the dose, fractionation and technique of following palliative scenarios with bone metastasis considering there are other visc...

1 Answer available

When offering palliative radiation for spinal cord compression, do you ever "open up the field" if there is evidence of leptomeningeal disease on MRI?

If so, what are your typical treatment volumes in this scenario?

1 Answer available

Do you use a comprehensive volumetric, rather than numeric, cutoff in consideration of SRS vs WBRT for brain metastases?

If a patient has a limited number of brain metastases (e.g., <3 total) but the additive volume of these intracranial metastases is high (e.g., each...

1 Answer available

How would you manage a patient with a high-risk asymptomatic bone metastasis with a driver mutation?

For example, if the patient had an ALK+ NSCLC initiating targeted therapy, would you offer prophylactic radiotherapy as per Gillespie et al., PMID 377...

1 Answer available

Do you routinely treat oligoprogressive metastatic sites with SBRT in patients receiving systemic therapy and otherwise stable disease?

We have been receiving referrals for oligoprogressive SBRT for multiple primary tumors (NSCLC, Colorectal, Renal Cell, etc.) in the setting of diffuse...

2 Answers available

Is there a role for XRT in the treatment of epistaxis from hereditary hemorrhagic telangiectasia?

1 Answer available

What is the expected timeframe for the development of radiation myelitis and therapies that have helped with neurologic symptoms?

4 Answers available

Should I treat a patient who doesn't know she has cancer?

My patient’s family has asked that I don’t tell her that she has metastatic cancer because it will devastate her. I am planning on palliat...

4 Answers available

Would you offer 12-16 Gy in a single fraction for a symptomatic, non-vertebral bone metastasis?

Treating to 12 to 16 Gy in 1 fraction, I based on the new ASTRO Clinical practice guideline, PRO April 2024

2 Answers available

Does your practice currently use low-dose radiation in the treatment of osteoarthritis?

In patients with bone metastases and osteoarthritis, if it is unclear if the pain is from cancer or OA, how do you decide on the radiation dose/fracti...

1 Answer available

Can trastuzumab deruxtecan be continued during radiation?

The patient has extensive disease, and requires palliative radiation to the scapular area (proximal to the brachial plexus) in a region overlapping wi...

1 Answer available

How would you manage a cardiac metastasis from Merkel cell carcinoma?

The patient has an asymptomatic metastasis in the left atrial appendage. Would you start off with immunotherapy then add radiation later, or visa ver...

1 Answer available

How would you palliate a metastatic lesion abutting a joint with an associated effusion?

In palliating a painful bone metastasis that abuts a joint and which is associated with a joint effusion, would you treat the entire joint space to ad...

1 Answer available

Would you consider palliative RT in the setting of tumor causing osteonecrosis in an elderly patient?

Patient has not received radiation therapy in the past. If not, what would you offer for palliation of pain?

1 Answer available

Is there a role for radiation in palliating malignant small bowel obstruction?

Does histology (radioresistant or radiosensitive) play into this decision?

2 Answers available

What is the quickest palliative regimen you have tried for obstructing lesions in the lung in patients with stage IV disease?

Anyone here doing 17 Gy in 2 fx?

2 Answers available

Can you give Pluvicto with concurrent palliative EBRT?

If so, do you modify your external beam dose?

1 Answer available

What are magic mouthwash alternatives that you would recommend?

There was a recall on viscous lidocaine and many of our patients cannot find it. What would you recommend as alternatives?

9 Answers available

Is it safe to give spine SBRT after recent cryoablation?

How would you treat a patient that had a T10 lytic lesion with extension to posterior 10th rib s/p cryoablation of the rib 4 months ago, but with resi...

1 Answer available

Do you offer palliative whole liver radiation for patients with diffuse liver metastases?

What dose-fractionation scheme do you utilize? Are there particular groups of patients this would not be a good option for (i.e. histologies of diseas...

3 Answers available

How would you manage a solitary unresectable liver metastasis?

From NCCN (Rectal MS-33): SBRT is a reasonable option for patients who cannot be resected or ablated. What is the role of SBRT versus microwave ablat...

2 Answers available

Is it reasonable to delay radiation therapy following surgical decompression for a patient with spinal cord compression if systemic therapy must be started as soon as possible?

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 ...

4 Answers available

How do you manage hot flashes in men with prostate cancer on androgen deprivation therapy?

16 Answers available

How do you approach and manage anorexia and appetite loss in people with advanced cancer?

How do you counsel patients and caregivers? Do you prescribe medications (''appetite stimulants'') with the goal to improve appetite even if they do n...

4 Answers available

Do you recommend holding tyrosine-kinase inhibitors for extracranial metastases being treated with SBRT?

If a patient has thoracic metastases being managed with EGFR TKI, do you refrain from SBRT treatment, do you hold the TKI, or can you treat the patien...

1 Answer available

Should 4 Gy x 5 be the standard of care for spinal cord compression in patients with poor prognosis?

The randomized SCORE-2 trial demonstrated equivalent survival (median 3 vs 3.7 months), response rates (72% vs 74% ambulatory at 1 month), and du...

1 Answer available

For bone metastases requiring surgical stabilization, what time interval from the date of surgery do you use for post-op radiation?

What is the maximum time that can be used (given the complexities with patient being in the hospital or needing rehab)?

2 Answers available

Do you routinely obtain a spine MRI for all patients planned for palliative spine RT?

Do you routinely obtain a spine MRI prior to treatment for all cases, even for non-SBRT candidates (e.g., 30 Gy in 10 fractions) or do you ever rely s...

4 Answers available

How do you approach the management of a patient with lumbar spinal metastasis with neurologic symptoms but without evidence of spinal cord compression?

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...

1 Answer available

When considering re-irradiation of a critical organ, should EQD2 or BED be utilized?

1 Answer available

What criteria do you use to decide whether to start anticonvulsants in patients with brain metastases?

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

1 Answer available

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 do you typically sequence chemotherapy and palliative radiation for metastatic endometrial and cervical cancers?

If a patient is found to have multiple painful osseous lesions but is chemotherapy naive, do you typically wait for the patient to undergo treatment w...

1 Answer available

Do you use either memantine or hippocampal sparing technique to preserve cognitive function when giving whole brain radiotherapy?

If so, have you noticed differences in cognitive function post WBRT?

7 Answers available

Do you modify the whole brain radiation dose if a patient has previously been treated with SRS for brain metastases?

0 Answers available

Is it safe to deliver palliative spine radiation concurrently with sacituzumab govitecan?

If not, how do you sequence the therapies?

2 Answers available

Do you continue to obtain dedicated imaging of the spine after palliative radiation for epidural disease or cord compression?

For example, in a patient with an expected long-term prognosis?

1 Answer available

How would you manage a treatment-naive patient who has painful vertebral lesions from ES-SCLC?

For patients with painful SCLC vertebral metastases and no evidence of cord compression, would you recommend treating with immediate systemic therapy ...

1 Answer available

Do you prescribe prophylactic steroids with spine SBRT?

Does fractionation (or location) influence this decision? What is your preferred steroid dose?

2 Answers available

How aggressive would you be in irradiating asymptomatic bone metastases in a patient with metastatic prostate cancer?

Notably, the patient presented with renal failure due to ureteral obstruction and hydronephrosis, receives hemodialysis, and has limited systemic opti...

4 Answers available

How do you approach image-guidance and creation of ITV/PTV margins for rib SBRT?

In contrast to lung SBRT, rib lesions may not have a clear lesion on CT that can be delineated to create an ITV after 4DCT. Do you create an ITV, and ...

1 Answer available

Is there a role for re-irradiation of a recurrent keloid?

Does the time interval between the intial RT and recurrence influence your decision? What time interval would you feel is appropriate? What dose would...

2 Answers available

Do you recommend prostate RT for patients with metastatic (M1) disease?

A recent NCBD analysis (Rusthoven et al., PMID 27325855) suggests that the addition of prostate RT significantly improves survival compared to AD...

8 Answers available

Is there any role for palliative radiation in the treatment of pericardial metastases?

Assuming the patient is symptomatic and/or has compression of ventricles, what field design and dose-fractionation would you use?

2 Answers available

Would you offer palliative RT for a patient with a pelvic mass fistulizing to large bowel?

The patient has metastatic ovarian cancer, currently on Avastin, with a large 13 cm pelvic mass with a fistula to large bowel. Would you consider off...

1 Answer available

How have the results of the phase III RTOG 0631 trial impacted your use of spine SBRT?

In the phase III RTOG 0631 trial, patients with 1 to 3 vertebral metastases were randomized 2:1 to either SRS (16 or 18 Gy in 1 fraction) or cEBRT (8 ...

2 Answers available

Is it safe to deliver palliative radiation to the spine with a spinal stimulator device in place?

Is it safe to deliver palliative radiation to the spine with a spinal stimulator device with standard palliative dosing (8 Gy x 1 fx, 20 Gy/5 fx or 30...

1 Answer available

Would you offer re-irradiation for recurrent vaginal bleeding?

The patient has stage IV cervix cancer and was previously treated to 30 Gy in 10 fractions one year ago. Embolization for hemostasis was not successfu...

2 Answers available

What is your response to the question, "Is this terminal?"

How do you "have the talk" in a way that is straightforward without emotionally crushing the patient?

8 Answers available

Will you treat brain mets with SRS in patients who cannot undergo MRI?

In patients with contraindications to receiving an MRI scan, are other imaging modalities sufficient to treat patients with SRS?

5 Answers available

Should hippocampal-avoidance WBRT be the default option for WBRT?

The idea would be to appropriately cover gross disease/lesions in/around the hippocampus, but then spare the rest of the hippocampus, with the rationa...

2 Answers available

How can oncologists be more collaborative with palliative care physicians?

How can these interactions be improved?

1 Answer available

What dose and fractionation would you use for metastasis to the rectus muscle of the eye?

1 Answer available

How would you treat a patient with metastatic cancer with a lesion invading the small bowel causing bleeding and potential obstruction?

Is radiation effective in this case and if so, what dose would you use? Is there potential for perforation?

2 Answers available

Would you offer SBRT to an oligometastatic non-vertebral bony site that already has a pathologic fracture?

1 Answer available

Would you consider post-operative SBRT following long bone stabilization (i.e. femoral intramedullary nail) for radioresistant tumors?

If not constrained by field size, would you treat the entire hardware length?

1 Answer available

Do you ever consider hypo-fractionated palliative radiation postoperatively for bone metastases?

Guideline statements recommend 30 Gy in 10 fractions postoperatively due to lack of evidence for other fractionation schemes. Would you consider 20/5 ...

3 Answers available

How do you avoid epilation in patients hoping to preserve their facial hair during radiotherapy?

Groomed facial hair is an increasingly common style for men. Accordingly, there are patients who require treatment of the head and neck who become ups...

5 Answers available

How do you prefer to manage multiple or numerous symptomatic skull metastases in a patient without brain metastases?

1 Answer available

What is your go to steroid regimen for post SRS headache?

If a patient calls you after hours with a headache following SRS and have not been given steroids, what is your preferred regimen?

1 Answer available

In light of the recent MSKCC Phase 2 data indicating reduced skeletal events with treatment, how will you approach management of patients with asymptomatic bone mets?

How will you approach patients with diffuse metastases who you would have otherwise deferred treatment? Prophylactic Radiation Therapy vs. Standard-o...

2 Answers available

Do you ever prophylactically treat an asymptomatic bone metastasis to prevent or delay risk of pathologic fracture?

If a patient with good PS who does not meet criteria for prophylactic rod stabilization has radiographic features consistent with metastasis (lytic ap...

5 Answers available

Do you use any particular dose constraints in patients receiving whole-brain radiation in the setting of prior SRS?

Does the previous dose of SRS or the fact the patient had prior surgery matter when planning WBRT?

1 Answer 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 ever offer spine SBRT for patients with multiple adjacent involved vertebrae?

Is there a limit to the number of adjacently involved vertebrae where you would instead treat with conventionally fractionated palliation?

1 Answer available

Should SBRT for bone metastasis be delivered daily, or every other day?

1 Answer available

How would you treat a symptomatic tongue metastasis?

2 Answers available

What are your preferred dose/fractionation options for treatment of hemoptysis related to central lung metastasis?

Does your management change if the primary tumor is radioresistant, such as renal cell carcinoma?

1 Answer available

Would you offer palliative re-irradiation to the sacrum for a patient with a prior history of RT for rectal cancer?

The patient has disease in the S2/S3 region with an anterior soft tissue mass. The patient previously received 50.4 Gy with treatment for rectal canc...

4 Answers available

How do you approach re-treatment if a patient still has pain from spine metastasis after 30Gy in 10 fractions?

What dose/fractionation scheme do you use? Is SBRT a viable option? How long after the first treatment should one wait?

3 Answers available

What dose/fractionation scheme would you employ to palliate a metastatic colon cancer patient with several large painful anterior abdominal wall lesions?

The patient had previously recurred twice in the abdominal wall, and was treated with resection. The patient has developed AML since that time and is ...

1 Answer available

Are there circumstances where you would use hemibody irradiation?

In patients with large areas of painful bone metastases, do you ever do hemibody? If so, what is the preferred dose?

3 Answers available

What is palliative RT technique would you use to treat a secondary lymphoma of the scrotum without skin involvement?

The patient’s tumor spans 6 cm depth within the scrotum, with no skin involvement. What is your preferred beam arrangement? With photons, woul...

2 Answers available

How would you approach a patient with symptomatic spinal cord compression who is a poor surgical candidate and has a radio-resistant primary tumor?

Would you consider SBRT in this instance? If so, then how would you approach this case if the patient's extent of disease was suboptimal for SBRT?

2 Answers available

Do you hold nivolumab and ipilimumab when giving palliative radiation to abdominal targets?

1 Answer available

Is axitinib with concurrent spinal RT safe?

Is concurrent axitinib contraindicated if a patient is to be treated with conventionally-fractionated spinal RT (e.g., is not a candidate for spinal S...

1 Answer available

Can you re-treat vertebral metastases with SBRT?

If a patient had 35 Gy in 5 fractions to a vertebral bone metastasis with SBRT two years ago, how much more can I give now to the whole vertebra with ...

1 Answer available

What dose constraints do you use when palliating pelvic structures in 5-10 fractions?

For example, when palliating rectal or gynecologic bleeding in 5 fractions? What structures do you contour and what dose constraints do you utilize?

1 Answer available

How do you decide whether to recommend surgical stabilization prior to RT for a femoral neck metastasis?

How do you take into account the following factors: The degree of pain and/or ambulation impairment, the extent cortical destruction, and/or lytic vs...

1 Answer available

Is it safe to give large fraction stereotactic irradiation for brain metastases concurrently with VEGF inhibitors?

0 Answers available

How long do you delay post-op radiation for cord compression if there is superficial proximal scar dehiscence?

How long do you wait to radiate post spinal separation surgery for multilecord compression if there is superficial dehiscence of proximal scar?

1 Answer available

What margins (CTV and PTV) do you use for palliation when using Quad Shot regimen?

And does this differ by site (e.g. gyn vs head and neck)?

4 Answers available

Are there any volumetric constraints associated with toxicity in the dose range that is moderately above prescription (i.e. 30-35 Gy range), when planning hippocampal-sparing whole brain radiation?

While protocols describe using a D2% constraint, there is little description of what should happen to the DVH between 30-37.5 Gy. It would ...

1 Answer available

Would you offer palliative radiation for painful bone metastases in a patient with scleroderma?

1 Answer available

How should the V10 or V12 be defined when evaluating intracranial SRS plans?

Should it include the entire brain (normal brain + target) or just the normal brain (brain - target)? How does the V10 or V12 constraint change ...

3 Answers available

How many vertebral levels do you choose to treat with post-op RT?

There are many cases where patient has cord compression in 1-2 vertebral levels, but surgery was done with hardware encompassing 5-7 levels. Are you c...

2 Answers available

How do you manage muscle pain and irritation due to radiation?

What medications (ibuprofen, steroids, muscle relaxers) due you use? Are there any non-medication management options?

2 Answers available

Are there extra precautions required for SBRT to a lesion that is proximal to an aortic aneurysm?

1 Answer available

If vertebral body pain is not controlled with a single 8 Gy fraction, what non-SBRT dose scheme would you consider for re-treatment?

The patient has metastatic NSCLC with painful metastases of the cervical spine, and is in between cycles of chemotherapy

3 Answers available

What is an acceptable maximum "bridging" dose between SRS/SRT targeted brain metastases in close proximity to one another?

What maximum dose do you allow to “connect” adjacent metastatic lesions receiving SRS/SRT? What is this value for one-, three-, and five-...

2 Answers available

Would you consider palliative radiation for a bone metastasis while patient is on pembrolizumab and axinitib?

The patient has a lesion of the manubrium.

1 Answer available

For someone with asymmetric Graves ophthalmopathy, do you still treat both eyes, or target the single affected orbit?

1 Answer available

How would you approach the treatment of a single vertebral body involved with multiple myeloma (MM)?

What dose/fractionation scheme and treatment volumes are most appropriate? Could you consider treating a single vertebral level with SBRT if do...

2 Answers available

Would you consider SBRT for an intraocular/choroidal metastasis?

If so, what dose/fractionation and constraints would you recommend?

2 Answers available

Do you take any special precautions when treating cervical spine metastases?

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

1 Answer available

Is there an age cut off below you would not treat a keloid with radiation post surgical excision?

Assuming it has previously been treated with excision and steroid injections? Is it reasonable to treat a bothersome keloid in a pediatric patient aft...

6 Answers available

In the modern era, what is the role of beta-emitting bone-targeted radiopharmaceutical therapy?

Are you offering patients beta-emitters (Samarium-153 lexidronam, strontium-89) to any patients?

1 Answer available

How would you manage an osseous lesion that received palliative SBRT with no pain relief?

If there is no pain relief after 9 months, is additional radiation reasonable? What dose/fractionation would be safe and likely to be effective?

2 Answers available

Would you hold off on whole brain radiotherapy for a patient with metastatic NSCLC and multiple asymptomatic brain metastases and will be starting immunotherapy?

5 Answers available

What dose and fractionation would you give for gastric cancer patient with solitary FDG-avid metastasis to gluteal muscle?

Is 30 Gy/10 fractions acceptable, or is another dose/fractionation scheme ideal?

1 Answer available

Would you hold cabozantinib for radiation therapy, or is concurrent use safe?

1 Answer available

What do you consider to be the minimum technological requirements to safely deliver spine SBRT?

For instance, are there 1. Specific Linac features, such as a certain MLC leaf width, 6-DOF couch, etc? 2. Requisite on board imaging/IGRT capabilit...

2 Answers available

Do you recommend treatment of the entire extent of the hardware and/or bone when treating a bone metastasis that has received pre-irradiation surgical stabilization?

For example, would you treat the entire length of the femur after prophylactic intramedullary rod fixation for a femoral neck metastasis?

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 dose constraints are appropriate for SBRT treatment to a 5 cm neck metastasis from renal cell carcinoma?

What constraints should be used for skin, thyroid and cricoid cartilage, and trachea when treating in 5 fractions?

1 Answer available

When should you use single-fraction radiotherapy for spinal cord compression?

Based on the SCORAD III trial, will you now be treating patients with spinal cord compression with single-fraction radiotherapy? Is there anyone ...

5 Answers available

What data is there for using SRS to treat more than 3 lesions?

1 Answer available

How would you treat a bone oligometastasis that required surgical fixation for pathologic fracture?

Do you treat all surgical hardware to a conventional palliative dose? Do you treat the metastasis with SBRT? Would you treat both with a simultaneous ...

1 Answer available

How do you manage leptomeningeal carcinomatosis from a metastatic solid tumor?

Do you prefer WBRT, IT chemo or targeted systemic therapy and what is your preference on the sequence of therapies?

2 Answers available

How do you approach breast conserving therapy in a woman who has formed bothersome keloids after prior surgeries?

Is there any alteration in approach from the medical, surgical, or radiation oncology perspective that can mitigate the risk of forming keloids withou...

3 Answers 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

What is the role of preoperative radiation in patients with bone metastases needing surgical stabilization (ie. ORIF), but without tumor resection?

If a patient has a large femoral metastasis that cannot be resected, but is to be stabilized with ORIF which will push tumor into the distal end of th...

1 Answer available

In a patient with ectopic splenic tissue causing symptomatic mass effect in the pelvis, would you approach radiation differently than you would splenomagaly due to a hematologic malignancy?

Would you consider doses >4-10Gy?

1 Answer available

What are reasonable SBRT dose constraints for the lumbosacral plexus?

In treating an oligometastatic lesion in the sacrum, is it reasonable to extrapolate from RTOG brachial plexus contraints (eg, 8 Gy/fx for a 3-fractio...

4 Answers available

What dose constraints would you use for the heart/pericardium when treating a sternal metastasis with five-fraction SBRT?

How does this differ in the de novo versus reirradiation setting?

1 Answer available

How long would you wait before considering additional treatment to the same site if bone metastasis pain fails to improve after 8 Gy x 1 fraction?

9 Answers available

Is it appropriate to offer combination lung SBRT and immunotherapy for oligometastatic melanoma outside of a clinical trial?

If so, can these be administered concurrently?

0 Answers available

What is an appropriate steroid regimen for a patient treated with RT for spinal cord compression?

How long do you continue high dose dexamethasone after radiotherapy? Does your tapering regimen depend on the clinical response to treatment?

1 Answer available

What is the anticipated recovery of bone marrow hematopoiesis after palliative radiation therapy?

How does this vary with dose-fractionation schedule or location of bone being palliated? What is the expected time frame for recovery?

0 Answers available

When would you recommend radiation therapy for an asymptomatic pathologic fracture in a vertebral body?

Would your recommendation change based on disease extent? What other factors would you consider?

2 Answers available

How do you manage cranial radiotherapy in the setting of an acute CVA?

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

1 Answer available

Can a second course of SRS be used to treat a brain met that initially responded to SRS and then progressed?

If progression is proven by imaging modality (MRI spectroscopy, perfusion and PET/CT), is there evidence for retreatment with a second course of SRS?&...

3 Answers available

How do you approach hotspots/heterogeneity for palliative radiation plans?

For treatments such as whole brain radiation or palliative spine radiation, is there a certain hotspot value you try to limit the plan to (i.e. <10...

2 Answers available

When do you recommend prophylactic orthopaedic stablization of a long bone metastasis perceived to have high risk of pathologic fracture?

These situations often arise in patients with a poor prognosis and the recovery time from such a procedure may not be trivial. In what cases would you...

1 Answer available

What SABR dose-fractionation would you use when treating an oligometastatic site in the femur or weight-bearing acetabulum?

The COMET trial excluded femur sites.

1 Answer available

What is your preferred technique and dose/fractionation for treatment of a metastasis involving the retina or optic nerve?

1 Answer available

Would you utilize single fraction palliative radiation therapy for a large bone metastasis?

Is there a certain size threshold you use? Does location of the lesion (e.g. spine) matter? What other cases do you feel are not ideal candidates for ...

2 Answers available

When do you recommend prophylactic treatment of spinal metastasis(-es) after initial identification on staging imaging for a metastatic solid tumor?

This assumes no current local pain symptoms or spinal cord compression. Does this recommendation change based on histology? Any other factors to consi...

1 Answer available

How would you approach palliation of a symptomatic cervical cancer involving the supraclavicular lymph nodes?

Patient with stage IIB cervical cancer treated 8 years ago, now with large (>10cm), isolated, symptomatic recurrence involving the left SCL and med...

1 Answer available

How would you manage newly diagnosed spinal cord compression presenting with paraplegia without tissue confirmation?

0 Answers available

What dose-fractionation would you utilize to treat an oligometastatic rib lesion for durable local control?

How would your recommendation change for a lesion within a non-radiated field versus a previously radiated field? What about an oligoprogressive lesio...

1 Answer available

How do you manage palliative pelvic radiotherapy in a patient receiving Avastin?

Do you hold Avastin before and after radiation therapy? Do you avoid radiation in these patients?

1 Answer 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

Do you routinely contour spinal nerves as avoidance structures for spine SBRT/SRS cases other than those for the brachial and lumbosacral plexuses?

Is this different for de novo or reirradiation cases? Would you recommend avoidance of the nerve roots if there is gross disease present in these area...

1 Answer available

How do you decide the right time to transition to hospice?

Obviously, patient and caregiver preferences are paramount. But, what factors do you consider? Does expanded hospice (e.g., Medicare Care Choices) inf...

4 Answers available

Would you recommend cardiac radiotherapy for malignant pericardial effusion refractory to pericardial fenestration?

Would you consider using radiotherapy for persistent malignant pericardial effusion? What dose-fractionation would you use, and what would your ...

1 Answer available

How do you manage neurocognitive decline associated with chemotherapy (i.e. chemo brain)?

Is there specific workup you perform? Are there preventive measures? Once established, are there non-pharmacological and pharmacological treatments yo...

3 Answers available

What is the best way to treat a small brainstem met with stereotactic radiosurgery?

7 Answers available

What is your thought process for dose prescriptions when treating abdominal/pelvic lymph node oligometastasis with SBRT?

For that occasional "single lymph node metastasis" referral in patients with no other sites of disease, is there a therapeutic dose below which you're...

5 Answers 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

What dose constraint do you use for the ostomy site when treating a patient with close/adjacent disease?

1 Answer available

What is the largest non-spine bone metastasis you would be willing to treat with SBRT?

Is your size limit a function of OAR dose? If yes, is there a volume of bone that you will not exceed regardless of no dose-limiting OARs?

1 Answer available

What dose do you recommend for an oligometastatic bone metastasis involving the glenoid?

Is 1000 cGy x 3 fractions to a portion of glenohumeral joint safe?

2 Answers available

What is a safe and effective dose and fractionation for palliating head and neck cancer?

10 Answers available

Is there evidence for dose escalation of large bony metastases secondary to hepatocellular carcinoma?

1 Answer 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

How do you counsel patients on the neurocognitive effects of whole brain radiation therapy?

Specifically, how do you explain potential cognitive decline in a way that explains what changes they can expect in their daily lives?

1 Answer available

What dose and fractionation would you recommend for post-operative treatment of an isolated femur metastasis after surgical stabilization?

6 Answers available

Does location of an non-spinal osseous metastasis affect your SBRT dosing?

What is your normal dose-fractionation in this scenario? Do you change your dosing if the lesion is in a weight bearing structure (femoral head/neck,...

2 Answers available

What MRI sequences do you utilize for spine SRS treatment planning?

Do you include a T1 post-contrast series?

2 Answers available

What are the roles of whole brain radiotherapy and stereotactic radiosurgery for hemorrhagic brain metastases?

Is urgent whole brain radiotherapy indicated for certain histologies such as choriocarcinoma from GTN or testicular origin? If SRS is employed, how sh...

1 Answer available

Would you recommend radiation therapy for a pathologic vertebral compression fracture already treated with kyphoplasty and RFA (OsteoCool)?

1 Answer available

What is your surveillance imaging schedule after whole brain radiotherapy for brain metastases?

3 Answers available

How do you approach a patient with avascular necrosis and symptomatic bone met in the region?

Would you offer palliative radiation? Would you fractionate differently?

1 Answer available

Would you consider prone SBRT (with solid image guidance techniques) if bowel is lying on a target, for instance bowel surrounding an oligometastatic lymph node or next to a kidney tumor?

1 Answer available

Do you attempt to spare a strip of skin for palliative 8 Gy x 1 fraction radiation treatments?

1 Answer available

Would you offer radiation therapy for pleural- or peritoneal-based pseudomyxoma peritonei?

If so, how would you approach your radiotherapeutic plan and what dose-fractionation would you utilize?

1 Answer available

In what situations would you consider treating metastases to the spine with proton SBRT?

2 Answers available

When would you treat Dupuytren's contracture with radiation?

Would you treat Dupuytren’s contracture shortly after surgery or wait till patient develops new contracture? What dose and fractionation do you ...

3 Answers available

How are you integrating IMRT into whole brain radiation for brain metastases?

Are you waiting for final publication of NRG CC-001? If already routinely using, any challenges with insurance approval, plan turnaround time, or oth...

2 Answers 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

Would you offer RT to a large infiltrative renal metastasis in a patient with minimal other systemic disease?

What factors would you consider? What if this meant treatment of the full kidney? If treatment is recommended, would you utilize an SBRT approach...

2 Answers available

In which patients do you prescribe Marinol?

Any absolute contraindications?

1 Answer available

Would you continue treatment of a rectal metastasis in a patient who is found to have radiographic evidence of contained rectal perforation during the treatment?

Would you continue treating the patient (in spite of the risk of causing a frank perforation, sepsis, and subsequently devastating consequences), or w...

1 Answer available

At what point do you refer patients to see a pain specialist?

Do you have a "threshold" quantity/dose of opioids above which you are uncomfortable prescribing?

1 Answer 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

What dose constraint do you use for the spinal cord in the setting of re-irradiation?

What factors do you consider when determining this constraint? For example, in a patient who was previously treated to 30 Gy in 10 fractions, how woul...

2 Answers available

How do you manage new brain metastases in patients on trastuzumab emtansine (TDM-1) who has controlled extracranial disease?

A case series from Colorado raises concern over significant radiation necrosis with SRS. However, there doesn't seem to be much additional negative li...

1 Answer available

When do you feel it is safe to initiate palliative radiation therapy to the bone (spine, femur, humerus, etc.) following surgical fixation with hardware (with or without cement) without compromising the stability of the hardware?

1 Answer available

How long after initiation of steroids do you typically recommend waiting prior to delivering radiation therapy for spinal cord compression?

3 Answers available

At what field size would you consider splitting a palliative spine treatment into two different courses?

If you are treating a very large palliative spine field that encompasses several vertebral levels, would you consider splitting the field (treating ha...

1 Answer available

After completing SRS for brain mets, how long should the medical oncologist wait before starting chemotherapy?

Would this be any different for whole brain radiotherapy?

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

What is your recommended dose-fractionation when treating with SBRT for a non-spine bone metastasis?

For example, what is a safe dose for SBRT for a ~5 cm colorectal bone metastasis of the acetabulum?

1 Answer available

What dose-fractionation would you use to treat a single large melanoma lung metastasis?

How does your fractionation choice change if the lesion is abutting the pleura?

1 Answer available

Do you treat early-stage dupuytrens disease with radiotherapy?

Would you use adjuvant radiotherapy after xiaflex injection or needle aponeurotomy?

2 Answers available

Do you routinely hold immunotherapy during whole brain radiation?

2 Answers available

Do you have any recommended techniques or tips for palliative radiation to a digit (e.g. thumb)?

Would you take any special precautions with dosing or care for fingernail toxicity?

1 Answer available

Do you change dose and fractionation when repeating RT for heterotopic ossification prophylaxis?

1 Answer available

What criteria do you use when selecting a multi-fraction vs single fraction approach for treatment of spine metastases with radiosurgery?

1 Answer available

What sites for SBRT are thought to be more immunogenic for antigen presentation when combined with immunotherapy?

If given options of liver, lung, spine, brain, axilla, or other lymph nodes which sites do you pick?

1 Answer 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

Would you recommend post-operative radiation to an oligometastatic subcutaneous lesion resected with positive microscopic margins?

If so, how would you approach treatment?

1 Answer available

What is your cutoff for the maximum number and size of brain metastases that you will treat with SRS?

5 Answers 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 there evidence to suggest that SRS/SBRT for spine or bone metastases provides faster and more durable palliative relief or soft tissue decompression than a fractionated course?

1 Answer available

What is your preferred approach for the management of choroidal oligometastases?

How do you decide between plaque brachytherapy and external beam approaches? What dose do you use for plaque brachytherapy? For external beam, what do...

1 Answer available

What is the appropriate target volume for SBRT to a non-vertebral osseous metastasis?

Does your volume change based on fractionation (high-dose single fraction vs. 3-5 fractions)? Do you treat the entire circumference of long bones? Wha...

1 Answer available

Does Neurosurgery need to be consulted for assessment of spinal stability in patients with cervical spine mets prior to starting RT?

Would you feel comfortable treating with palliative radiation without neurosurgical assessment? Are these patients at increased risk for neurolog...

1 Answer available

Is it preferable to offer hypofractionated SRT over single fraction SRS for brain metastases?

There are solid data from Emory, Korea and others suggesting that is as effective as single fraction SRS but has less complications.

3 Answers available

What criteria do you use when deciding whether to offer radiation for thyroid associated ophthalmopathy?

1 Answer available

What dose and fractionation do you use for palliative radiotherapy of GI carcinoid tumor metastatic to spine/bone?

Are carcinoid tumors of the GI tract more or less radiosensitive than typical solid tumors?

1 Answer available

How do you treat hiccups in cancer patients?

Does your management differ if the hiccups are felt to be related to chemotherapy as opposed to the disease itself?

1 Answer available

When do you recommend involving neurosurgery in the planning of SRS cases?

To what degree, if any, is a neurosurgeon involved in the planning of SRS for brain metastases?

2 Answers available

Is ASTRO's recommendation to avoid whole brain radiotherapy following SRS for limited brain metastases practical for patients treated in the community setting?

The 2014 "Choosing Wisely" list, released this past September, includes the assertion that we should not "routinely add adjuvant whole brain radiation...

6 Answers available

Is it necessary to treat one vertebral body above and below for palliation of spinal metastases?

In this age of IGRT, CBCT, and MRI imaging, is this practice needed?

2 Answers available

How do you treat a radioresistant (e.g. RCC or melanoma) oligometastases in a weight-bearing bone after surgical resection and stabilization?

If surgical stabilization has been performed, do you go with SBRT dosing? If so, do you treat only the involved site and not the extent of hardware? D...

1 Answer available

What is your preferred palliative radiation regimen for patients with painful bone metastasis?

Please share your decision algorithm, if any (based on age, histology, KPS, lines of therapy already used, prognosis, etc.).

1 Answer available

Would you consider SRS of non-progressive, stable intracranial lesions while treating with SRS for a single progressive brain metastasis after previous WBRT for multiple brain metastases?

1 Answer available

Is there a volume or size criteria where you feel that standard doses for palliative radiation (8Gy/1fx-30Gy/10fx) are not effective?

For example, in someone with a new diagnosis of hormone receptor positive breast cancer with a 10 cm lytic bone lesion extending out into the pelvis a...

1 Answer available

How do you account for artifact due to hardware, or what measures do you take, to optimize planning in the setting of a post-operative spine SBRT treatment?

2 Answers available

Are there technical alternatives to SRS for a radiation center without the requisite micrcollimator or cones, for patients with early crainal merastases?

1 Answer 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

When TPN is a barrier to enrollment in hospice for an eligible cancer patient with an irreversible malignant bowel obstruction, how do you approach the conversation about discontinuation of TPN?

The immediate response by patients in this situation seems almost universally to be, "But I'll starve to death!" Referencing literature about lack of ...

2 Answers available

What is the optimal dose fractionation for treating liver metastases in the central liver causing obstruction of biliary flow?

Will higher doses per fraction increase the risk of fibrosis and cause permanent impediment to biliary flow?

1 Answer available

Is it safe to use doses of 3Gy in a BID treatment for palliative urgent cases?

For example, if a patient had severe lung obstruction or hemoptysis from a tumor would it be okay to treat with 3Gy per fraction BID? Or, if a pa...

2 Answers available

What do you consider a radiation oncology emergency?

More specifically, what do you classify as a situation that needs treatment within 24 hours?

1 Answer available

Does radiation improve bone health and allow for healing of a pathological fracture in a patient with multiple myeloma refusing surgery?

What is the best evidence to support or refute this?

1 Answer available

Which chemotherapy should be held while delivering palliative radiation?

Does the site of palliative radiation therapy matter (i.e. femur, abdomen, pelvis vs base of skull)? How long should you wait to give palliative ...

1 Answer available

What is the best radiation therapy treatment for vertebral body metastasis with epidural extension adjacent to the spinal cord for radio-resistant tumors (melanoma, renal cell, etc.)?

1 Answer 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

In a patient with brain metastasis confined to the cerebellum, would it be reasonable to treat the posterior fossa only (vs WBRT)?

What are the best options to treat a patient with brain metastasis confined to the posterior fossa if the patient is young, has a favorable cancer, gr...

1 Answer available

How do you decide on a fractionation scheme for retreatment of a progressive/painful spine metastasis?

How does your fractionation change based on the time from the previous treatment, such as 6-12 months vs. greater than 12 months?

1 Answer available

What is the recommended initial treatment for spinal cord compression due to non-Hodgkin lymphoma (e.g. diffuse large B-cell lymphoma)?

When treating with radiation therapy, what dose-fractionation do you typically utilize?

1 Answer 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

Is there a field size in which you would consider single fraction palliative radiation unsafe?

For example, is 8 Gy x 1 well tolerated in the setting of multi-level vertebral body radiation?

1 Answer available

What is your approach for an inoperable patient with epidural spinal cord compression who has previously received maximum spinal cord dose during a previous course of radiation therapy?

How would your recommendation change based on interval from previous radiation?

1 Answer available

What criteria do you use for recommending palliative radiation in patients who are asymptomatic but have good performance status?

Does your dose-fractionation approach change in such cases?

1 Answer available

Do you have any advice when utilizing palliative radiation therapy in patients currently being treated with a PARP inhibitor?

Can the drug continue during radiation therapy or should it be discontinued at a specified time prior to initiation of radiation?

1 Answer available

Is there a role for Radium-223 in patients that have a non-prostate malignancy who otherwise would be a reasonable candidate?

1 Answer available

What is the best way to discuss an early palliative care referral with a patient?

We have a great palliative care clinic and I like to refer many patients with metastatic disease, even if I feel that they will live a year or two lon...

1 Answer available

Which targeted systemic agents should be held while delivering palliative radiation?

If the systemic agent is going to be held, how many days prior to starting radiation therapy should the agent be held and when can it be restarted aft...

3 Answers available

In patients with vertebral bone metastases, what criteria do you use to select patients for kyphoplasty referral prior to palliative radiotherapy?

Does your criteria change if you are considering SBRT?

1 Answer available

What dose would you give for unresectable anaplastic thyroid carcinoma?

Is there a hypofractionated dose regimen that would be suitable for palliation prior to the patient going to hospice?

2 Answers available

Is there an effective therapy for radiation myelitis?

For a patient who has completed 40 hyperbaric sessions with steroids with little improvement, what other options exist?

1 Answer available

Do you treat supraclavicular metastasis with SBRT?

If so what dose-fractionation do you use and what constraints for brachial plexus?

1 Answer available

When do you prescribe steroids prior to palliative radiotherapy of bone metastases to prevent pain flare?

The Canadian study presented at ASTRO 2015 showed a decrease in pain flare prior to single dose 8Gy RT, but steroids were given for 5 days prior to RT...

1 Answer available

Should early referral to palliative care be standard of care for all patients with metastatic cancer?

I know that some would argue that healthy patients with an excellent performance status may not need an early palliative care referral, but wouldn't i...

3 Answers available

For elderly patients with locally advanced rectal cancer who are not candidates for surgery or chemotherapy, what would be an appropriate palliative regimen?

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

How do you manage patients without a pathologic diagnosis of malignancy referred for palliative radiation?

Do you handle a non-emergent indication such as palliation for pain vs cord compression differently in a patient unwilling to undergo a biopsy?

1 Answer available

When should SBRT be offered to oligometastatic bone disease in a patient with prostate cancer?

What factors should be considered with offering SBRT to oligometastatic bone disease in prostate cancer patients? Should this been done off of a proto...

2 Answers available

Would you treat the whole brain for brain metastases in a patient with active systemic scleroderma?

In a patient with multiple brain metastases from NSCLC, is this reasonable?

1 Answer available

What is the biggest mistake people make when starting a linac SRS program?

Any advice on how to safely incorporate it into our practice?

2 Answers available

What is the maximum time you would allow between simulation/treatment planning MRI and delivered treatment for stereotactic radiosurgery for brain metastases?

How do the number of lesions treated and histology affect your decision making?

1 Answer available

What is the rate of dementia following whole brain radiotherapy in patients with brain metastases who survive for over a year?

The most frequent argument against whole brain RT is debilitating toxicity. However, I am having a hard time finding the most evidence based data on h...

1 Answer available

How are patients on anticoagulation managed in the context of intracranial SRS?

Is heparin or warfarin routinely held prior to treatment?

1 Answer available

What size cut-off do you suggest for the safe administration of SRS in the setting of brain metastases?

In RTOG 9508, 4 cm was the cut-off size for WBRT followed by SRS.

1 Answer available

Is it appropriate to treat patients with limited metastases with whole brain radiotherapy and a concurrent simultaneous integrated boost?

In reading through the policy of one of my state's private insurance companies, I came across something with which I'm not familiar, namely treating p...

1 Answer available

When re-irradiating the spinal cord, what do you use as a guideline for the interval between treatment and the amount of tolerance theoretically "regained"?

I'm aware of a number of publications that suggest that after 1-2 years, the cord should be able to handle about 50% of the original tolerance dose. &...

3 Answers available

What clinical factors help you to determine whether or not a patient is an appropriate candidate for spine SRS/SBRT in the setting of metastatic disease?

1 Answer available

How do you stereotactically treat brain metastases greater than 3 cm +/- additional brain mets?

It is my impression that for brain metastases >3 cm it may be preferable to deliver fractionated SRT versus the RTOG dose of 15 Gy SRS, if WBRT is ...

1 Answer 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

Should I decline to treat a patient with a first site of metastasis who refuses a biopsy?

More specificlaly, in a non-emergent situation?

1 Answer available

How do you best palliate metastatic skin and subcutaneous melanoma lesions?

Do you hypofractionate or add any concurrent systemic therapy? What specific dose-fractionation regimens do you recommend?

1 Answer available

Do you cover vasogenic edema surrounding the GTV when treating brain metastasis with SRS?

1 Answer available

Is it safe to give localized palliative spinal radiation with concurrent intrathecal cytarabine? If so, do doses need to be adjusted?

1 Answer available

Papers discussed in this category

Radiother Oncol, 2005-11-01

The 'QUAD SHOT'--a phase II study of palliative radiotherapy for incurable head and neck cancer.

Anticancer research, 2017-02

Hypofractionated Palliative Radiotherapy with Concurrent Radiosensitizing Chemotherapy for Advanced Head and Neck Cancer Using the "QUAD-SHOT Regimen".

Gynecol Oncol, 2019 Aug 16

Advanced communication: A critical component of high quality gynecologic cancer care: A Society of Gynecologic Oncology evidence based review and guide.

JAMA,

The care of the patient.

Cochrane Database Syst Rev, 2006-10-18

Palliative radiotherapy regimens for non-small cell lung cancer.

Clin Oncol (R Coll Radiol), 1996-01-01

Randomized trial of palliative two-fraction versus more intensive 13-fraction radiotherapy for patients with inoperable non-small cell lung cancer and good performance status. Medical Research Council Lung Cancer Working Party.

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.

International journal of radiation oncology, biology, physics, 1994-07-30

Late effect of multiple daily fraction palliation schedule for advanced pelvic malignancies (RTOG 8502).

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.

Pract Radiat Oncol, 2019 Nov

Salvage Curative-Intent Reirradiation Stereotactic Body Radiation Therapy for Isolated Pelvic and/or Paraortic Recurrences of Gynecologic Malignancies.

Neuro-oncology, 2013-10

Memantine for the prevention of cognitive dysfunction in patients receiving whole-brain radiotherapy: a randomized, double-blind, placebo-controlled trial.

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

Preservation of memory with conformal avoidance of the hippocampal neural stem-cell compartment during whole-brain radiotherapy for brain metastases (RTOG 0933): a phase II multi-institutional trial.

J. Clin. Oncol., 2020 Feb 14

Hippocampal Avoidance During Whole-Brain Radiotherapy Plus Memantine for Patients With Brain Metastases: Phase III Trial NRG Oncology CC001.

Lancet, 2016 Sep 2

Dexamethasone and supportive care with or without whole brain radiotherapy in treating patients with non-small cell lung cancer with brain metastases unsuitable for resection or stereotactic radiotherapy (QUARTZ): results from a phase 3, non-inferiority, randomised trial.

Neuro-oncology, 2018-04-09

Memantine prevents acute radiation-induced toxicities at hippocampal excitatory synapses.

Int J Radiat Oncol Biol Phys, 2000 May 1

Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumors and brain metastases: final report of RTOG protocol 90-05.

International journal of radiation oncology, biology, physics, 2016-10-01

Stereotactic Radiosurgery for Brainstem Metastases: An International Cooperative Study to Define Response and Toxicity.

Radiation oncology (London, England), 2012-07-11

Prescription dose and fractionation predict improved survival after stereotactic radiotherapy for brainstem metastases.

CNS Oncol, 2016 Jul

Why hypofractionate stereotactic radiosurgery for brain metastases?

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.

Int J Radiat Oncol Biol Phys, 2006 Dec 1

Update of human spinal cord reirradiation tolerance based on additional data from 38 patients.

International journal of radiation oncology, biology, physics, 2010-03-01

Radiation dose-volume effects in the spinal cord.

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

Reirradiation human spinal cord tolerance for stereotactic body radiotherapy.

The New England journal of medicine, 2010-08-19

Early palliative care for patients with metastatic non-small-cell lung cancer.

The New England journal of medicine, 2013-03-28

Generalist plus specialist palliative care--creating a more sustainable model.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2015-05-01

Early Versus Delayed Initiation of Concurrent Palliative Oncology Care: Patient Outcomes in the ENABLE III Randomized Controlled Trial.

JAMA, 1998 Nov 4

Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial.

Journal of neurosurgery, 2010-12

Radiosurgery alone for 5 or more brain metastases: expert opinion survey.

Lancet Oncol, 2014 Apr

Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational study.

J Neurosurg, 2014 Dec

Stereotactic radiosurgery for patients with multiple brain metastases: a case-matched study comparing treatment results for patients with 2-9 versus 10 or more tumors.

Stereotactic and functional neurosurgery, 2017

Impact of the Number of Metastatic Tumors Treated by Stereotactic Radiosurgery on the Dose to Normal Brain: Implications for Brain Protection.

Cancer treatment reviews, 2011-11

Stereotactic radiosurgery and hypofractionated stereotactic radiotherapy: normal tissue dose constraints of the central nervous system.

Practical radiation oncology, 2011

Early clinical outcomes for 3 radiation techniques for brain metastases: focal versus whole-brain.

Stroke, 2008 Jul 17

Establishing final infarct volume: stroke lesion evolution past 30 days is insignificant.

J Neuroimaging, 2020 Feb 10

From "Time is Brain" to "Imaging is Brain": A Paradigm Shift in the Management of Acute Ischemic Stroke.

J Can Assoc Radiol, 1975-09-01

The 1975 Gordon Richards Memorial Lecture. Is the Miles operation really necessary for the treatment of rectal cancer?

Int. J. Radiat. Oncol. Biol. Phys., 1995-01-15

Adenocarcinoma of the rectum treated by radical external radiation therapy.

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2009-12

Brachial plexopathy from stereotactic body radiotherapy in early-stage NSCLC: dose-limiting toxicity in apical tumor sites.

International journal of radiation oncology, biology, physics, 2012-10-01

Development of a standardized method for contouring the lumbosacral plexus: a preliminary dosimetric analysis of this organ at risk among 15 patients treated with intensity-modulated radiotherapy for lower gastrointestinal cancers and the incidence of radiation-induced lumbosacral plexopathy.

Medical physics, 2010-08

Stereotactic body radiation therapy: the report of AAPM Task Group 101.

International journal of radiation oncology, biology, physics, 2009-07-01

Phase II study of high-dose photon/proton radiotherapy in the management of spine sarcomas.

Journal of surgical oncology, 2014-08

Long-term results of Phase II study of high dose photon/proton radiotherapy in the management of spine chordomas, chondrosarcomas, and other sarcomas.

International journal of radiation oncology, biology, physics, 2018-03-15

Concurrent Immune Checkpoint Inhibitors and Stereotactic Radiosurgery for Brain Metastases in Non-Small Cell Lung Cancer, Melanoma, and Renal Cell Carcinoma.

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

Stereotactic Radiosurgery: Treatment of Brain Metastasis Without Interruption of Systemic Therapy.

Int. J. Radiat. Oncol. Biol. Phys.,

Improved Overall Survival and Locoregional Disease Control With Concurrent PD-1 Pathway Inhibitors and Stereotactic Radiosurgery for Lung Cancer Patients With Brain Metastases.

Radiat Oncol, 2015 May 27

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Integrating palliative care into the trajectory of cancer care.

Int J Radiat Oncol Biol Phys, 2021 Aug 25

Thecal Sac Contouring as a Surrogate for the Cauda Equina and Intracanal Spinal Nerve Roots for Spine Stereotactic Body Radiation Therapy (SBRT): Contour Variability and Recommendations for Safe Practice.

J Med Imaging Radiat Oncol, 2014 Apr 09

External evaluation of the Radiation Therapy Oncology Group brachial plexus contouring protocol: several issues identified.

Int J Radiat Oncol Biol Phys, 2020 Nov 18

CCTG SC.24/TROG 17.06: A Randomized Phase II/III Study Comparing 24Gy in 2 Stereotactic Body Radiotherapy (SBRT) Fractions Versus 20Gy in 5 Conventional Palliative Radiotherapy (CRT) Fractions for Patients with Painful Spinal Metastases.

Radiother Oncol, 2018 May 26

Randomized phase II trial evaluating pain response in patients with spinal metastases following stereotactic body radiotherapy versus three-dimensional conformal radiotherapy.

International journal of radiation oncology, biology, physics, 2015-03-01

Cost-effectiveness analysis of single fraction of stereotactic body radiation therapy compared with single fraction of external beam radiation therapy for palliation of vertebral bone metastases.

JAMA Oncol, 2023 Apr 20

Stereotactic Radiosurgery vs Conventional Radiotherapy for Localized Vertebral Metastases of the Spine: Phase 3 Results of NRG Oncology/RTOG 0631 Randomized Clinical Trial.

JAMA, 2019 Apr 16

Effect of Doxepin Mouthwash or Diphenhydramine-Lidocaine-Antacid Mouthwash vs Placebo on Radiotherapy-Related Oral Mucositis Pain: The Alliance A221304 Randomized Clinical Trial.

Head Neck, 2016 Mar 29

Effectiveness of honey on radiation-induced oral mucositis, time to mucositis, weight loss, and treatment interruptions among patients with head and neck malignancies: A meta-analysis and systematic review of literature.

The Lancet. Oncology, 2017-05

Prevention of everolimus-related stomatitis in women with hormone receptor-positive, HER2-negative metastatic breast cancer using dexamethasone mouthwash (SWISH): a single-arm, phase 2 trial.

BMC Cancer, 2014 Sep 15

Surveillance or metastasis-directed Therapy for OligoMetastatic Prostate cancer recurrence (STOMP): study protocol for a randomized phase II trial.

JAMA oncology, 2023 Jun 01

Addition of Metastasis-Directed Therapy to Intermittent Hormone Therapy for Oligometastatic Prostate Cancer: The EXTEND Phase 2 Randomized Clinical Trial.

EJNMMI physics, 2023 Feb 09

Investigation of image-based lesion and kidney dosimetry protocols for Lu-PSMA-I&T therapy with and without a late SPECT/CT acquisition.

JAMA oncology, 2019-06-01

Single-Fraction Stereotactic vs Conventional Multifraction Radiotherapy for Pain Relief in Patients With Predominantly Nonspine Bone Metastases: A Randomized Phase 2 Trial.

Lancet Oncol, 2021 Jun 11

Stereotactic body radiotherapy versus conventional external beam radiotherapy in patients with painful spinal metastases: an open-label, multicentre, randomised, controlled, phase 2/3 trial.

The Lancet. Oncology, 2022 Oct

European Society for Radiotherapy and Oncology and European Organisation for Research and Treatment of Cancer consensus on re-irradiation: definition, reporting, and clinical decision making.

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2023 Feb 20

Treatment plan optimisation for reirradiation.

Acta oncologica (Stockholm, Sweden), 2021 Sep 29

Dose summation and image registration strategies for radiobiologically and anatomically corrected dose accumulation in pelvic re-irradiation.

The spine journal : official journal of the North American Spine Society, 2017-10

Early intervention in cauda equina syndrome associated with better outcomes: a myth or reality? Insights from the Nationwide Inpatient Sample database (2005-2011).

Adv Radiat Oncol, 2021 May-Jun

Timing of Urgent Inpatient Palliative Radiation Therapy.

JTO clinical and research reports, 2023 Feb 02

Brief Report: Severe Pneumonitis After Combined Thoracic Radiotherapy and Osimertinib.

JTO clinical and research reports, 2023 Aug 17

Pneumonitis in Patients Receiving Thoracic Radiotherapy and Osimertinib: A Multi-Institutional Study.

Cancer, 2023 Jul 06

American Radium Society Appropriate Use Criteria for the use of liver-directed therapies for nonsurgical management of liver metastases: Systematic review and guidelines.

The Lancet. Oncology, 2023 Dec 08

MRI in addition to CT in patients scheduled for local therapy of colorectal liver metastases (CAMINO): an international, multicentre, prospective, diagnostic accuracy trial.

Cardiovascular and interventional radiology, 2023 Jul 10

Unresectable Intermediate-Size (3-5 cm) Colorectal Liver Metastases: Stereotactic Ablative Body Radiotherapy Versus Microwave Ablation (COLLISION-XL): Protocol of a Phase II/III Multicentre Randomized Controlled Trial.

Gastrointestinal endoscopy, 2011-06

Esophageal cancer patients undergoing external beam radiation after placement of self-expandable metal stents: is there a risk of radiation dose enhancement?

Gastrointestinal endoscopy, 2023 Nov 10

Colonic-enteric lumen-apposing metal stents: a promising and safe alternative for endoscopic management of small-bowel obstruction.

Anticancer research, 2021 Apr

Colon or Rectal Stent Positioning for Advanced Cancer Influences Quality of Life: A Critical Point of View.

Cancers, 2022 Nov 30

Management and Prognosis of Cardiac Metastatic Merkel Cell Carcinoma: A Case-Control Study and Literature Review.

JAMA network open, 2024 Feb 05

Stereotactic Body and Conventional Radiotherapy for Painful Bone Metastases: A Systematic Review and Meta-Analysis.

International journal of radiation oncology, biology, physics, 2024 Jan 11

An Economic Analysis of SC24 in Canada: A Randomized Study of SBRT Compared With Conventional Palliative RT for Spinal Metastases.

Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al], 2021 May 05

New clinical data on human spinal cord re-irradiation tolerance.

International journal of radiation oncology, biology, physics, 2013-03-01

Randomized trial of pentoxifylline and vitamin E vs standard follow-up after breast irradiation to prevent breast fibrosis, evaluated by tissue compliance meter.

International journal of radiation oncology, biology, physics, 2020 Jan 24

Randomized, Placebo-Controlled Clinical Trial Combining Pentoxifylline-Tocopherol and Clodronate in the Treatment of Radiation-Induced Plexopathy.

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2001 Mar

Double-blind randomized phase II study of hyperbaric oxygen in patients with radiation-induced brachial plexopathy.

Cancer research and treatment, 2006 Dec 31

The effect of pentoxifylline on radiobiological parameters in the rat radiation myelopathy.

Radiation Oncology

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