Emergent radiation therapy

A tumor mass (usually vertebral metastasis) compresses the cord or cauda; urgent decompression and/or radiation preserve neurologic function.

Symptomatic brain metastases with edema, mass effect, or impending herniation require emergent management and often urgent whole-brain or focal radiation.

Tumor seeding of the leptomeninges causes multifocal neurologic symptoms; whole-brain or craniospinal irradiation and intrathecal therapy are palliative options.

External compression of the SVC, most often by a mediastinal tumor (lung cancer, lymphoma), causes facial and upper-body swelling and venous engorgement.

A large anterior mediastinal mass compresses the trachea or great vessels, creating a true emergency with stridor and orthopnea.

Lung cancer eroding into bronchial vasculature can cause life-threatening hemoptysis; radiation produces rapid vasoconstriction and tumor shrinkage.

Persistent bleeding from bladder, cervical, or vaginal tumors uncontrolled by other measures is a classic palliative radiation indication.

Esophageal cancer obstructing the lumen causes inability to swallow saliva and nutrition; radiation relieves obstruction and restores intake.

Endobronchial tumor obstructing a main bronchus causes atelectasis, pneumonia, and respiratory compromise; radiation reopens the airway.

A lytic lesion in a weight-bearing bone at high fracture risk requires stabilization and/or radiation to prevent a completed fracture.

Severe uncontrolled pain from osseous metastases is a common urgent palliative indication; single-fraction RT is effective for uncomplicated bone pain.