How do you approach lung tumors with vessel encasement, especially in someone with active hemoptysis?

It's a good question and not one that has a ton of published data to support. If you look at the GYN literature for palliation of vaginal bleeding, hypofractioned RT can be a very useful treatment, suggesting a role in other sites. My impression is always that those are very vascular malignanies and the majority of the blood is coming from tumor related seeping, rather than direct invasion of pelvis/uterine vessels. Hence a quick tumor response dries up the seeping small vessels, giving palliation.

You're describing something potentially different. You say "encasement" and "hemoptysis" and are connecting them, which we do see in thoracic tumors. Sometimes tumors directly invade vascular structures and the hemoptysis is a result of that invas...