Neuro-Oncology   

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 ...

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Would this be any different for whole brain radiotherapy?

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

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

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

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

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

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...

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

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

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

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

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

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...

Is heparin or warfarin routinely held prior to treatment?  

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

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...

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. &...

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 ...