Beyond the First Dose: Re-irradiation for Brain Tumors - Maximizing Outcomes and Managing Risk

This activity explores the use of repeat radiation for intra-cranial neoplasms. Radiation is the primary management modality for the treatment of a number of intracranial pathologies and the initial treatment is well studied and relatively standardized across the specialty. However, in the setting of recurrent disease, in a wide range of conditions, there is value of further radiation that currently is likely underutilized, but can benefit patients. This spans high grade malignant brain tumors such as glioblastoma as well as low grade primary brain tumors. Additionally, the management of meningioma can be challenging and the panel discusses treatment strategies including emerging infusional radiopharmaceuticals. The management of brain metastases, as the most common intracranial malignancy, is explored in the setting of re-irradiation. The panel explores the gamut of technologies, including protons, in the presentation. Finally, the panel discusses strategies and techniques to minimize risk as well as interventions to help manage potential toxicity.

Topics:

  1. Re-irradiation of Primary Brain Tumors – Tips and Techniques
    Daniel Trifiletti, MD
  2. Re-irradiation of Brain Metastases: When and How
    Joshua Palmer, MD
  3. Q and A – Part 1
    Stuart H. Burri, MD - Moderator
    Full Panel
  4. Mitigation and Management of Toxicity in the Re-irradiation of Brain Tumors
    Christina Kehl Cramer, MD
  5. Q and A – Part 2
    Stuart H. Burri, MD – Moderator
    Full Panel

This activity is available from June 16, 2026, through 11:59 p.m. Eastern time on June 15, 2028. 

The content was originally presented and recorded at the 2025 ASTRO Annual Meeting.

Target Audience

The activity is designed to meet the interests of medical oncologists, radiation oncologists, surgeons, physicists, radiation therapists, radiation dosimetrists and residents.

Learning Objectives

Upon completion of this activity, participants should be able to:

  • Determine which patients would benefit from re-irradiation of their primary or secondary brain tumor.
  • Assess the various radiation techniques, technology and fractionation to optimally benefit patients while mitigating risk of toxicity.
  • Analyze strategies to manage toxicities that may develop from re-irradiation.
Course summary
Available credit: 
  • 1.25 AMA PRA Category 1 Credit™

    The American Society for Radiation Oncology (ASTRO) is accredited by the Accreditation Council for Continuing Medical Education for physicians. ASTRO designates this Enduring material for a maximum of 1.25 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

  • 1.25 Certificate of Attendance
    This activity was designated for 1.25 AMA PRA Category 1 Credit™.
Course opens: 
06/16/2026
Course expires: 
06/15/2028
Cost:
$149.00
Rating: 
0

Moderator:  

  • Stuart H. Burri, MD, is employed by Southeast Radiation Oncology Group. Dr. Burri has ownership equity in Charlotte Physics Holding, FUSE Oncology Holding, Oncology Practice Solutions, Radiation Oncology Centers of the Carolinas and Southeast Radiation Oncology Group.   

Speakers:

  • Daniel M. Trifiletti, MD, is employed by Mayo Clinic Jacksonville. Dr. Trifiletti receives honoraria from AFX-medical, Sevier pharmaceuticals and Boston Scientific. Dr. Trifiletti receives grant/research funding from Varian. 
  • Joshua Palmer, MD, is employed by The Ohio State University Wexner Medical Center. Dr. Palmer receives honoraria from ICOTEC, Varian Medical Systems and Carbofix. Dr. Palmer receives grant/research funding from The Ohio State University. 
  • Christina Kehl Cramer, MD, is employed by Wake Forest University School of Medicine. Dr. Cramer has no relevant financial relationship with ineligible companies to disclose. 

Planners:

  • Malcolm Mattes, MD is employed at Rutgers Cancer Institute. Dr. Mattes received research/grant funding from Gilead Sciences (relationship ended 8/30/2025). Dr. Mattes has no relevant financial relationship with ineligible companies. 
  • Parul Barry, MD, is employed by the University of Pittsburgh Medical Center. Dr. Barry has no relevant financial relationship with ineligible companies. 
  • Michael Haddock, MD, is employed by Mayo Clinic and has no relevant financial relationship with ineligible companies to disclose.
  • Manisha Palta, MD, is employed by Duke Cancer Center and Duke University Hospital. Dr. Palta receives grant/research funding from Merck and Varian Medical Systems. 
  • Salma Jabbour, MD, is employed by Rutgers Cancer Institute. Dr. Jabbour receives grant/research funding from Merck & Co., Inc. and Beigene. Dr. Jabbour receives compensation/payment as a consultant with Radialogica and IMX Medical. 
     

All relevant financial relationships have been mitigated.

The American Society for Radiation Oncology (ASTRO) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Available Credit

  • 1.25 AMA PRA Category 1 Credit™

    The American Society for Radiation Oncology (ASTRO) is accredited by the Accreditation Council for Continuing Medical Education for physicians. ASTRO designates this Enduring material for a maximum of 1.25 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

  • 1.25 Certificate of Attendance
    This activity was designated for 1.25 AMA PRA Category 1 Credit™.

Price

Cost:
$149.00
Please login or register to take this course.

Course Fees:
ASTRO members must log in to the ASTRO website to view and receive the member rate.

  • Nonmember: $149
  • Member: $99
  • Member-in-Training: $49
  • Student/Graduate Student/PGY-1 Member: $49
  • Postdoctoral Fellow Member: $49

If you are an ASTRO member from a low or lower-middle income country, as identified by the World Bank, you can receive a 50% discount off your corresponding registration for this activity. Please email [email protected] to inquire about the discount.

Policies:
No refunds, extensions, or substitutions will be made for those participants who, for any reason, have not completed the activity by the expiration date. 

Participants using ASTRO Academy activities to satisfy the requirement of a Continuing Certification (MOC) program should verify the credit number and type and availability dates of any activity before making a purchase. No refunds, extensions, or substitutions will be made for participants who have purchased activities that do not align with their MOC requirement.

The activity and its materials will only be available on the ASTRO website until June 15, 2028, regardless of purchase date. At the expiration of the activity, participants will no longer have access to the activity or its materials. ASTRO reserves the right to remove an activity before its expiration date. 

Required Hardware/software

One of the two latest versions of Google Chrome, Mozilla Firefox, Internet Explorer or Safari.