Radiation Oncology

Palliation   

Questions discussed in this category



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

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,...

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

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...

Would you offer palliative radiation? Would you fractionate differently?

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

I have a patient with metastatic NSCLC and a concurrent head and neck primary.

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

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

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...

A recent NCBD analysis (Rusthoven et al, JCO 2016) suggests that the addition of prostate RT significantly improves survival compared to ADT alon...

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

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

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

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

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

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...

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...

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

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

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

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

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

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

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

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

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

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

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

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

Would you treat if the patient is asymptomatic?  If you do treat, what dose/fractionation would you use?

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

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...

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. 

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

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

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

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...

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...

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

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...

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

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

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

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

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...

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

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 ...

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...

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

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

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

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

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...

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...

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

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

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

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

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...

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...

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...

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

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

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

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

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

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

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...

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...

The retrospective series quote a local control rate of 85-90% at one year and the current NCCN guidelines list this as an option following surgery for...

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. &...

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...

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...

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 ...

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

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

Do you hypofractionate or add any concurrent systemic therapy? 

I am curious as to how others approach this question coming from a patient with metastatic cancer. How do you "have the talk" in a way that is straigh...


Papers discussed in this category


Radiother Oncol, 2005-11-01

Anticancer Res, 2017 Feb

Cochrane Database Syst Rev, 2006-10-18

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

Int J Radiat Oncol Biol Phys, 2013 Sep 1

Clin Oncol (R Coll Radiol), 2007 Sep

Radiat Oncol, 2014 Jan 3

Int J Radiat Oncol Biol Phys, 1994 Jul 30

Radiother Oncol, 2011 Nov

Neuro Oncol, 2013 Oct

J Clin Oncol, 2014 Dec 1

Int J Radiat Oncol Biol Phys, 2000 May 1

Int. J. Radiat. Oncol. Biol. Phys., 2016 Jun 15

Radiat Oncol, 2012 Jul 11

CNS Oncol, 2016 Jul

N Engl J Med, 2007 Aug 16

J Clin Oncol, 1999 Jul

Lancet, 2015 Jan 3

Int J Radiat Oncol Biol Phys, 2011 Nov 1

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

J Thorac Oncol, 2017 Sep 4

Lancet Oncol., 2017-05-01

N. Engl. J. Med., 1999-08-12

BMC Cancer, 2015-08-15

J Cancer Res Ther, 2012 Jul-Sep

Int J Radiat Oncol Biol Phys, 2012 May 1

Neurosurgery, 2013 Oct

Pract Radiat Oncol, 2015 Jan-Feb

J. Neurosurg., 2005-01-01

J Korean Neurosurg Soc, 2011-08-01

Radiat Oncol, 2014-07-08

BMC Cancer, 2015-03-04

Acta Neurochir (Wien), 2013-01-01

Int J Radiat Oncol Biol Phys, 2006 Dec 1

Int J Radiat Oncol Biol Phys, 2010 Mar 1

Int J Radiat Oncol Biol Phys, 2012 Jan 1

N Engl J Med, 2010 Aug 19

N Engl J Med, 2013 Mar 28

J Clin Oncol, 2015 May 1

Lancet Oncol, 2009 Nov

JAMA, 1998 Nov 4

J Clin Oncol, 2011 Jan 10

J Neurosurg, 2010 Dec

Lancet Oncol, 2014 Apr

J Neurosurg, 2014 Dec

Stereotact Funct Neurosurg, 2017 Oct 11

Cancer Treat Rev, 2011 Nov

Pract Radiat Oncol, 2011 Oct-Dec

J Can Assoc Radiol, 1975-09-01

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

Radiother Oncol, 2009 Dec

Int J Radiat Oncol Biol Phys, 2012 Oct 1

Med Phys, 2010 Aug

Int J Radiat Oncol Biol Phys, 2018 Mar 15

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

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

Radiat Oncol, 2015 May 27

Int. J. Radiat. Oncol. Biol. Phys., 2016 Feb 02

J. Clin. Oncol., 2017 Jan 23

N. Engl. J. Med., 2016 Oct 08

N. Engl. J. Med., 2017 Nov 18

N. Engl. J. Med.,

Br J Radiol,

Burns, 2014 Apr 24

Pediatrics, 2012 Dec 17

Pediatrics, 2016 Jan 07

Eur Urol, 2015 Jul 16

BJU Int, 2009 Feb

Eur Urol, 2014 Jun

Radiat Oncol, 2011-05-15

Int J Radiat Oncol Biol Phys, 2006 Feb 1

J Neuroophthalmol,

J Neurosurg Spine, 2012 Apr

Anticancer Drugs, 2016-06-01

Pract Radiat Oncol, 2011 Apr-Jun

N Engl J Med, 2014 Mar 27

N Engl J Med, 2013 Jun 20

J Clin Oncol, 2014 Dec 1

Cancer, 2008 Sep 1

J Clin Oncol, 2008 Apr 1

Lancet Oncol., 2010-02-01

J Clin Oncol, 2006 Mar 20

J. Urol., 2005-08-01

J Clin Oncol, 2002 Aug 1

J Clin Oncol, 2011 Jun 20

J Urol, 2002 Sep

Clin Cancer Res, 2009 Jan 15

Nature, 2005 Dec 8

N. Engl. J. Med., 2001-12-06

Lancet, 2001-09-22

Breast Cancer Res. Treat., 2010-02-01

J. Urol., 1982-06-01

Cancer Res., 2000-04-15

J. Clin. Oncol., 2009-04-01

Oncol. Rep., 2015-12-01

Nat Commun, 2015-04-01

PLoS ONE, 2016-01-01

J. Urol., 2002-04-01

Eur. Urol., 2018-02-01

Lancet, 2018 Oct 18

Lancet Oncol, 2014 Feb

Int J Radiat Oncol Biol Phys, 2016 Jun 1

Radiat Oncol, 2011-12-21

Turk J Med Sci,

Radiat Oncol, 2015-03-28

J Clin Oncol, 2011 Aug 1

Lancet Oncol., 2016 Oct 24

Lancet, 2004 May 22

Pract Radiat Oncol, 2015 Apr 6

Radiother Oncol, 2016-10-01

Can Fam Physician,

J Natl Cancer Inst, 2005 Jun 1

Int J Radiat Oncol Biol Phys, 2011 Mar 15

Radiother Oncol, 1999-08-01

Radiother Oncol, 1998-06-01

Int J Radiat Oncol Biol Phys, 2009 Apr 1

Spine (Phila Pa 1976), 2007 Jan 15

J Neurosurg, 2004 Nov

Clin Lung Cancer, 2011-11-01

Cancer, 2010 May 1

Int J Radiat Oncol Biol Phys, 2011 Mar 15

Spine (Phila Pa 1976), 2010 Oct 15

Oncologist, 2017-08-01

Spine, 2016-10-15

Pract Radiat Oncol, 2014 Mar-Apr

Ann Palliat Med, 2016 Jan

Clin Oncol (R Coll Radiol), 2015-05-01

J Pain Symptom Manage, 2008 Mar

Lancet, 2005 Aug 20-26

Radiother Oncol, 2002-07-01

Int J Radiat Oncol Biol Phys, 2014 Sep 13

Int J Radiat Oncol Biol Phys, 2009 Sep 1

Lung Cancer, 1994-03-01

N Engl J Med, 2017 Nov 16

J Neurosurg Spine, 2012 Jul

Int J Radiat Oncol Biol Phys, 2010 Jun 1

J Clin Oncol, 2013 Sep 20

Future Oncol, 2015

Future Oncol, 2015 Oct 15

J. Clin. Oncol., 2009 Sep 08

Strahlenther Onkol, 2010 Jan 28

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

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

Cureus, 2017 Dec 25

Int. J. Cancer, 2016 Jun 30

Health Aff (Millwood),

Cancer, 2017 Dec 20

Radiat Oncol, 2018 Mar 20

Neurosurgery, 2017 Aug 28

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

Radiother Oncol, 2017 Mar

Biomed Res Int, 2018 Dec 13

Technol. Cancer Res. Treat., 2017 Nov 21

J Clin Oncol, 2013 Nov 1

Lancet Oncol, 2016 Jul

J Thorac Oncol, 2019 Feb 16

Int. J. Radiat. Oncol. Biol. Phys., 2019 Aug 31

Lung Cancer, 2019 Jan 15

N. Engl. J. Med.,

JAMA Oncol, 2016 Nov 17

Neuro-oncology, 2019 Feb 23