Medical Oncology


Questions discussed in this category

What role, if any, does molecular testing play in diagnosis and management in the absence of available clinical trials?

Margins are negative (closest 4mm), grade 2, 3 of 23 lymph nodes positive with no extranodal extension. What is your preferred chemotherapy approach a...

The patient presented with spinal cord compression, had subtotal resection and instrumentation with metallic hardware. Main concern is that post op su...

Patient initially achieved CR with VAC-IE with resolution of presumed lung mets and 100% necrosis in LLE primary tumor on BKA. Then was NED again afte...

No evidence of distant disease elsewhere. Surgical resection is not possible. Would you recommend metastasis direct therapy to the liver (i.e. SBRT or...

Would you use gem/docetaxel, anthracycline-based regimens or targeted therapies?

Ewing sarcoma of the right lung, status post bi-lobectomy and adjuvant VDC/IE, with recurrence 6 years in the right lung only. He has reached a cumula...

With conflicting data from the EORTC RCT and the Sarcoma meta-analysis collaboration, what factors determine when you would offer adjuvant chemotherap...

How would you modify therapy for a younger, fit patient versus an older, frail patient? Lesions in stomach, small intestine, colon resulting in bleed...

What would be your radiation volumes/dose and choice of chemotherapy?

Would your treatment approach be similar for a patient with suboptimal performance status?

In particular, is there any data on the efficacy of Ipilimumab/Nivolumab?

Given that risk definitions are based on size, mitotic activity, location and not necessarily genetics/biology, would an otherwise low-risk GIST, who ...

What is the role for adjuvant versus neoadjuvant chemotherapy?

Patient with hepC and advanced cirrhosis with multiple liver mets, but may be able to tolerate oral TKI or PARP. Would you offer this or focus on hosp...

Performance status is excellent. Second surgical opinion has also confirmed need for amputation, as the recurrence is now breaching intra and extra ar...

Osteosarcoma conventional type of the distal right femur. cT1N0M0 G3 Stage IIA on MAP protocol completed NACT followed by surgery on radical resection...

This patient had resection of the primary, requiring multiple resections to obtain an R0 resection, followed by adjuvant radiation to the primary. The...

Since desmoid tumors are associated with high estrogen states, is there an optimal contraception approach? Is there an optimal time for pregnancy? How...

What is your preferred risk stratification model?  There does not appear to be a consensus among experts as to what cutoff in recurrence risk ju...

Post-auricular cutaneous angiosarcoma, pT1 (19 mm) with negative margins. Unclear if there is any indication for systemic therapy, given early stage a...

For example, gastric GIST, < 5 mitoses/hpf and size > 5 cm but < 10 cm is intermediate by NIH criteria but low by NCCN/CAP criteria.  Th...

If post-op with clear margins would you prefer adjuvant RT or close observation with surgery for optimal reduction of local recurrence? This particula...

No primary thoracic mass identified. Knowing these often following an aggressive clinical course, would you consider concurrent chemo/RT, incorporate ...

Would you consider adjuvant chemotherapy, radiation therapy, hormone therapy, or surveillance?

In patients with symptomatic disease that observation would not be appropriate, what is your preferred treatment?

Which Radiation modality, if any, would be preferred? Typical chemotherapy does not work for SFT. In which circumstance would you use VEGF ( Temozolo...

Data suggest patients with D842V-mutated or KIT/PDGFRA WT GIST do not respond to imatinib, but NCCN guidelines does not take into consideration mutati...

Should treatment be based on current histology (rhabdomyosarcoma) or origin (germ cell)?

Would you consider using recently approved agent for symptomatic / unresectable PN, Selumetinib prior to Systemic Chemotherapy in this setting?

For example, would you consider switching to an outpatient regimen in lieu of AIM for metastatic soft tissue sarcoma?

Would you consider regorafenib based on the REGOBONE trial? Or would you consider other agents knowing that we do not have positive survival data with...

Tumor 13 cm on back with retiform and kaposiform features; all margins negative except one abuts inked margin; atypical cells with 4 mitosis/HPF. Add...

How do you choose between single-agent or combination chemotherapy versus newer treatment strategies such as palbociclib?

For example, if a biopsy reads: lesion comprised of spindle cells arranged in a fascicular pattern, elongated, hyperchromatic nuclei, focally positive...

Would your recommendations change in the neoadjuvant versus adjuvant or metastatic setting?

i.e. doxorubicin, ifosfamide + RT. Do you worry about decreased locoregional control or increased toxicities with the use of G-CSF in combination with...

Is there an age limit you use to consider MAP? Would you consider using AIM instead?

How do you choose between local therapy (surgical debulking or ablation) v. 2nd line systemic therapy? Would you consider immunotherapy?

Given metastatic disease and not a trial candidate, how would you approach this scenario? How does an underlying diagnosis of NF1 affect your decision...

When, if ever, do you utilize adjuvant RT or chemotherapy?

NCCN suggests to consider continuation of imatinib from some single/multi institution non-randomized trials for ~2 years, but does not suggest what fa...

How would you treat metastatic, unresectable, solitary fibrous tumor in a patient with mild hemophilia A? Each anti-VEGF medication comes with a warni...

How does grade or performance status affect your treatment decisions?

Does anatomic location (eg retroperitoneal or thoracic) affect your treatment decision?

Given the recent press release regarding the update on the phase 3 soft tissue sarcoma study of LARTRUVO (olaratumab) showing no benefit to the combin...

I have seen favorable clinical trial reports on dasatinib for metastatic disease, but no data on possible adjuvant use.  NCCN guidelines suggest ...

What other pathologic features may you use to guide therapy decisions (eg mitoses/grade or NGS)?  If you decide on adjuvant therapy, what regimen...

Is there any data to suggest delayed initiation of adjuvant treatment would be beneficial? Or would close surveillance be reasonable? Patient is asymp...

CIC-DUX4 fusion sarcoma is a rare entity, the aggressiveness of which is comparable to Ewing's sarcoma. A major dilemma is whether to treat these pati...

Do you offer neoadjuvant RT with resection and node dissection vs. definitive radiation?  How extensive does the nodal disease have to be for you...

Tumor involves stomach, liver, and lymph nodes. Pathology is suspicious for sarcomatoid carcinoma, possibly sarcomatoid cholangiocarcinoma.

Papers discussed in this category

Cancer, 2021 Oct 13

JAMA Oncol,

Clin. Cancer Res.,

The Lancet. Oncology, 2009-11

Ann. Surg. Oncol., 2015 Feb 05

Oral Oncol., 2013 Nov 15

Cancer, 2009-07-15

Cancer, 2011-10-01

Hematol Oncol Clin North Am, 2019 Oct 28

Int. J. Radiat. Oncol. Biol. Phys.,


Eur. J. Cancer,

Clinical cancer research : an official journal of the American Association for Cancer Research, 2018-04-15


Cancer medicine, 2019-01


Thromb. Haemost.,

Cancer, 2010-10-01

European journal of cancer (Oxford, England : 1990), 2013-03

American journal of clinical oncology, 2019-01

World J. Gastroenterol.,

American Society of Clinical Oncology educational book. American Society of Clinical Oncology. Annual Meeting, 2018-05-23

Acta Oncol, 2017 Apr 21

Lancet Oncol., 2017 Sep 04

Lancet Oncol., 2012 Sep 04

Ann Surg Oncol, 2014 Aug

European journal of cancer (Oxford, England : 1990), 2012-06

The New England journal of medicine, 2018-12-20

Ann. Oncol., 2012 Feb 13

Case reports in oncology, 2017

BMC Cancer, 2015 Oct 15

Cancer, 2011-11-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 1997-06

Lancet Oncol., 2020 Feb 17

Lancet Oncol., 2018 Nov 23

Ann. Oncol., 2011 Apr 28

Sarcoma, 2020 Jan 30

Translational gastroenterology and hepatology, 2017

Surg Oncol, 2016 May 10

Journal of cutaneous pathology, 2014-11

Lancet Oncol., 2017 May 09

J Thorac Oncol, 2019 Nov 18

ESMO Open,

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 1998-01

Annals of surgery, 1982-09

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2012-11-20

Oncologist, 2020 Dec 01

The Lancet. Oncology, 2017-11

The Lancet. Oncology, 2018-03

The Lancet. Oncology, 2019-06

J Hematol Oncol, 2016 Jun 03

Annals of oncology : official journal of the European Society for Medical Oncology, 2014-12

J Clin Oncol, 2012 Feb 13

Ann Oncol, 2013 Apr 04

Cancer, 2018 Sep 14

Annals of surgery, 2014-05

Oncologist, 2018 Dec 12

Int J Radiat Oncol Biol Phys, 2020 Apr 11

Clin Sarcoma Res, 2013 Dec 18

The American journal of surgical pathology, 2008-01

Int J Part Ther, 2021 Jun 25

Annals of surgery, 2004-10