Clinical decision support that reasons like a radiation oncologist: treat malignant cord compression before the legs go, prescribe the right palliative schedule, plan curative intent with modern technique, and manage the toxicity — with the decision rule and exactly what would change it. Built for verified physicians.
Two real radiation-oncology questions, each reasoned the way HeyHippocrates answers: the skills fire, the answer is cited, the decision rule is explicit, and what's missing is flagged. Scroll to each.
Back pain with progressive leg weakness and a known vertebral metastasis, MRI shows epidural compression — the emergency plan?
Malignant spinal cord compression is an oncologic emergency, and the neurologic status at treatment is the strongest predictor of walking afterward — so act within hours. Start high-dose dexamethasone immediately and image the whole spine by MRI, since compression is often multilevel. Then decide the definitive treatment: surgical decompression followed by radiotherapy for a fit patient with a good prognosis, spinal instability or a single level, or primary radiotherapy otherwise. Treat urgently; every hour of delay costs function.
Decision ruleMalignant cord compression → high-dose dexamethasone now + whole-spine MRI; surgery then RT for the fit good-prognosis patient with instability or single level, else primary RT; treat within hours (neurologic status at treatment predicts ambulation).
Not established from this alone — the neurologic status, the stability and the prognosis change surgery versus primary radiotherapy.
An uncomplicated painful bone metastasis, no fracture or cord risk — the radiotherapy prescription?
For an uncomplicated painful bone metastasis, a single 8 Gy fraction relieves pain as well as a multi-fraction course, with a higher retreatment rate but far less burden for the patient — and single fraction is the evidence-based default. Reserve a fractionated schedule, such as 20 Gy in five or 30 Gy in ten, for an impending or actual fracture, the post-operative setting, or where durability matters. Consider stereotactic body radiotherapy for oligometastatic disease or reirradiation in selected patients. Match the schedule to the goal and the prognosis.
Decision ruleUncomplicated painful bone met → single 8 Gy (equal pain relief, higher retreatment, less burden); fractionate (20 Gy/5, 30 Gy/10) for impending or actual fracture, post-op, or durability; SBRT for oligometastatic or reirradiation; match schedule to goal + prognosis.
Not established from this alone — the fracture risk, the prognosis and the site change the schedule and the technique.
Illustrative simulations. The physician always decides.
The exact questions your field searches for — answered in the format the knowledge base speaks: the answer, the decision rule, what's missing, and the source.
Radiotherapy palliates several problems efficiently. For an uncomplicated painful bone metastasis, a single 8 Gy fraction is the default; brain metastases take whole-brain radiotherapy or, for a limited number, stereotactic radiosurgery; and short courses control tumor bleeding, obstruction and painful masses. Match the fractionation to the goal and the prognosis — fewer, larger fractions for a short life expectancy, more protracted courses only where durability or a curative-adjacent aim justifies the extra visits and toxicity.ASTRO · palliative
Decision rulePalliative RT: uncomplicated bone met → single 8 Gy; brain mets → whole-brain RT or SRS (limited number); short courses for bleeding/obstruction/mass; fewer larger fractions for short prognosis, protracted only where durability justifies it.
Missing data: the site, the prognosis and the goal change the schedule.
Treat it as an emergency the moment you suspect it. Give high-dose dexamethasone at once, and get an urgent MRI of the whole spine, because the compression is frequently at more than one level. Then choose the definitive treatment by fitness and prognosis: surgical decompression and stabilization followed by radiotherapy benefits the fit patient with a single area, instability or an unknown primary, while primary radiotherapy suits others. Speed matters — the ability to walk at the start of treatment is the best predictor of walking after.NICE · MSCC
Decision ruleSuspected malignant cord compression → dexamethasone + urgent whole-spine MRI; surgery then RT for the fit patient with single-level disease, instability or unknown primary, else primary RT; treat urgently — pre-treatment ambulation predicts post-treatment ambulation.
Missing data: the level, the fitness and the timing change surgery versus radiotherapy.
Curative radiotherapy exploits the greater repair capacity of normal tissue between fractions, so conventional schedules give small daily doses over weeks. Modern conformal techniques — intensity-modulated radiotherapy and volumetric arc therapy — shape the dose to the target while sparing the organs at risk, and stereotactic body radiotherapy delivers a few high-dose fractions to a small, well-defined target such as an early lung cancer. Define the target and the organs at risk carefully, respect the dose constraints, and combine with systemic therapy where the evidence supports it.radiotherapy principles
Decision ruleCurative RT: fractionation exploits normal-tissue repair (small daily doses over weeks); IMRT/VMAT conform dose and spare organs at risk; SBRT for small well-defined targets (e.g. early lung); careful target + organ-at-risk delineation and dose constraints; combine with systemic therapy per evidence.
Missing data: the tumor, the site and the organ-at-risk constraints change the dose and the technique.
Separate acute from late effects. Acute toxicity — skin erythema and desquamation, mucositis, esophagitis, diarrhea — appears during or soon after treatment in rapidly dividing tissues and usually resolves; manage it supportively with skin care, analgesia, nutrition and antidiarrheals. Late toxicity — fibrosis, stricture, xerostomia, secondary malignancy — emerges months to years later and is often irreversible, which is why sparing the organs at risk during planning is the real prevention. Grade the toxicity, treat the acute, and counsel on the late risk.toxicity management
Decision ruleAcute toxicity (skin, mucositis, esophagitis, diarrhea) during/soon after, in fast-dividing tissue, usually reversible → supportive care; late toxicity (fibrosis, stricture, xerostomia, second malignancy) months to years, often irreversible → prevented by organ-at-risk sparing at planning; grade, treat acute, counsel on late.
Missing data: the site, the dose and the timing change the toxicity and its management.
Your whole practice, one specialist brain — grounded in champion-authored, cited knowledge.
A generalist radiation-oncology colleague across palliative radiotherapy, the oncologic emergency, curative intent, toxicity, radiosurgery and combined therapy — cited, non-directive, always with the decision rule.
Deep specialist agents for palliative radiotherapy, central nervous system and stereotactic radiosurgery, thoracic and gastrointestinal sites, and toxicity management — each its own soul and knowledge base — plus your own uploaded materials.
From the cord-compression clock to the single-fraction call the margin is thin. Only one of these reasons like a radiation-oncology colleague whose every claim you can trace.
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It reasons in the frameworks you use — the palliative fractionation schedules, the cord-compression emergency pathway, curative-intent technique and the acute-versus-late toxicity model — and always shows the reasoning, the decision rule and what would change it. The decision always stays your call.
Both. Residents use it to pressure-test a plan and learn the decision rule; attendings use it as a fast, cited second opinion on the unit and at the console. Access is gated to verified physicians.
Palliative radiotherapy, central nervous system and stereotactic radiosurgery, thoracic and gastrointestinal sites, and toxicity management each have their own deep specialist agent on the Pro plan, on top of the full radiation-oncology scope on Basic.
No. It is physician-facing clinical decision support — a cited thinking partner. It does not diagnose, does not treat, and gives no patient-facing advice. The decision always stays with you.
Every answer is grounded only in champion-authored, cited radiation-oncology knowledge — traceable, not hallucinated — and always states the decision rule plus what data is missing, instead of a confident guess.
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