Neuro-Oncology   

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

When do you consider observation? 

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

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

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

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

What would be your next treatment for a young adult patient with medulloblastoma refractory to repeat resection, craniospinal irradiation, and initial...

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

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

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

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

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

What is the diagnostic yield and complication rate in your experience? 

NCCN lists PCV as category 1 (and now with analysis in Abstract 2002 from ASCO 2019 showing benefit in IDH mutated), and temozolomide as 2B, yet temoz...

For medical oncologists, would you offer a PD-1/L1 inhibitor? For other subspecialties, how would you counsel the oncologist regarding the risk of usi...

What would be your preferred technique and dose/fractionation?

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

Can intrathecal methotrexate be continued with close neurologic observation vs switch in treatment now due to findings?

If so, when do you consider this? 

Do you biopsy immediately, stop treatment, biopsy at a later time, or depend solely on the data you already have?

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

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

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

Length of temozolomide course when given with adjuvant radiotherapy

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

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

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

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

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