The benefit of risk.

You’ll be hard pressed to find a medical specialty more averse to risk than radiation oncologists. This editorial alludes to a salient point: you can’t push the needle for cancer care being a scaredy cat. The specific example is brain radiosurgery, where the prescription is classically altered on a gradient with increasing size of the target. Why? To avoid radionecrosis. But tumor control in this setting almost always trumps radionecrosis, the latter infrequently causing clinical significance beyond a course of steroids—in stark contrast to recurrent tumor. “We perhaps need to be reminded that, for many sites (including brain metastases), local tumor recurrence is often a worse toxicity than normal tissue injury.” | Milano, Int J Radiat Oncol Biol Phys 2022