Radiation Oncology

Sarcoma   

Questions discussed in this category


68 y.o. Male underwent inguinal orchiectomy and spermatic cord resection of a 5 cm malignant fibrous histiocytoma of the spermatic cord. Margins of re...

Did the publication earlier this year by Gundle et al. JCO 2018 (http://ascopubs.org/doi/pdf/10.1200/JCO.2017.74.6941) alter your concept of close mar...

What margins (if any) do you consider appropriate to not require adj RT? And would you ever consider neoadj RT?

Specifically the groin region? Or are there techniques or a change in the management style of radiation at these sites you would employ to minimize to...

If so, how do you choose your region of treatment? Dose? And elective nodal volume?

If margins are clear, would this tumor necessitate adjuvant radiotherapy? Synovial sarcomas often occur in a young patient subset, would this cause yo...

If so, what patients do you select for the boost? And what data do you give to adequately satisfy the insurance review and win approval?

After and extensive en bloc resection, is there further surgery that would be recommended? Is radiation alone sufficient? 

Would you treat these sites to definitive or post-operative doses? If not, is there a dose constraint you use at these sites? Do you use tighter margi...

Would certain patient/disease characteristics make you choose RT therapy over chemotherapy or other locally ablative therapies? What dose/fraction wou...

What things would you take into consideration for the simulation set-up? Specific instructions for treatment planning? If the PTV is confined to only ...

Is breast conserving surgery followed by radiation therapy an option? 

Do you follow pediatric protocols or treat this more like a high grade soft tissue sarcoma? Specifically for paratesticular pleomorphic RMS, do you ad...

What are some guidelines or principles that you use to recommend adjuvant radiation after complete resections of sarcoma? 

For example, in the setting of a lack of pre-operative imaging, what CTV margin(s) would you utilize for the initial and boost phases of treatment?

How does grade, margin status, and previous radiation dose factor into the recommendation? 

What time delay would make the benefit of adjuvant therapy likely no longer significant?

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

Is there any role for consolidative RT/CRT to the lung and mediastinum after initial chemo? What dose and fractionation would be most appropriate for ...

If so, how to you address the scar? Do you use bolus? Do you place a 2mm retraction from skin for the target contour?

With the high rates of recurrence postoperatively with angiosarcomas of the scalp, adjuvant radiation is often recommended.  What margins would y...

Most guidelines discuss target delineation and contouring recommendations for extremity sarcomas, which generally suggest larger longitudinal than rad...

For example, a patient with liposarcoma of the lower extremity status post preoperative radiation to 50 Gy who then underwent resection and had focall...

Would the dose change based if there was tumor adherent to bowel versus abdominal wall or muscle?

Would the histological grade or histology affect the dose? Would you consider dose escalating to the center of the tumor if this would not affect orga...

I am treating a resected high grade liposarcoma with positive surgical margins to 66Gy. I would prefer to use IMRT to spare the humerus, but ...

When the disease (in this case, lymphoma) involves almost all of the entire muscle compartment of the distal lower extremity, what is a safe dose? I'm...

And does your dose changes with positive margins? I can't seem to find a good answer in the literature.


Papers discussed in this category


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