Radiation Oncology

Sarcoma   

Questions discussed in this category


Final pathology showed grade 3 spindle cell sarcoma of thee vagina involving the anterior lateral cervix 5.6cm x 4.5 x 3.4cm, <0.1cm left lateral m...

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

Recent results from the STRASS trial suggest limited benefit from preoperative radiation therapy for retroperitoneal sarcomas.  https://pubmed.n...

More specifically there is no testicular invasion - would you cover the entire scrotal sac? What lymph node stations if any would you cover?

The interval since prior resection is between 3-5 years. Additionally, there is some evidence of nodal involvement but no evidence of metastatic disea...

Re-excision would result in amputation. And the patient had attempted pre-operative RT but quit at 16Gy due to toxicity/social reasons. Would you trea...

Would you use general sarcoma expansions or would smaller expansions like the ones in head and neck would be reasonable?

Specifically, when treating a tumor located in the head and neck region, would you consider treating closer to 64-66 Gy? Or would you be consistent wi...

When deciding to treat what would be your dose/volumes? And would a re-staging scan play a role in your treatment planning?

If a patient with a high grade sarcoma has gross residual/recurrent disease after resection and cannot undergo further surgery - would you boost this ...

What if it was status post partial resection? And had bilateral level 2 lymph nodes?

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

What dose schedule would you use to treat plantar fibromatosis? How soon after resection would you begin treatment? And how happy were you with the re...

When do you offer preop RT (50Gy) before the re-excision? When do you offer post-op RT after the re-excision?

The case in question is a radiation-induced spindle cell sarcoma at the thoracic spine previously treated for a plasmacytoma to a dose of 60 Gy in 30 ...

For both the primary and re-resection surgeries, resection was achieved via both scrotal and inguinal incisions. And margins were reported as negative...

Sometimes wound healing can delay adjuvant radiotherapy by several months. For aggressive histology, such as high grade sarcoma or skin cancers, is th...

Adverse features include increased nuclear size, nuclear atypia, and mitotic activity up to 10/50 HPF.

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

If there were negative margins, what other factors would you consider to add adjuvant RT? Size of the tumor or depth of invasion?  

Recurrence is in the radiation field right at the border of graft and scalp, and started to surface at about 20-24 Gy. It is visibly enlarging over se...

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...

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

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...

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


International journal of radiation oncology, biology, physics, 2012-07-15

Cancer, 1986-09-01

Cancer, 2010-03-15

International journal of radiation oncology, biology, physics, 2015-07-01

Lancet, 2002-06-29

The Lancet. Oncology, 2016-07

Cancer, 2006-07-15

Journal of radiation oncology, 2016

International journal of radiation oncology, biology, physics, 2007-04-01

The Journal of bone and joint surgery. American volume, 2009-03-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 1992-01

Int J Radiat Oncol Biol Phys, 2012 Nov 1

Cancer, 2003-04-15

International journal of radiation oncology, biology, physics, 2002-03-01

J Surg Oncol,

Breast Cancer Res. Treat.,

J. Clin. Oncol.,

International journal of radiation oncology, biology, physics, 1993-10-20

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

Radiother Oncol,

Eur. J. Cancer, 2014 Apr 11

Radiat Oncol, 2017 Jan 26

Practical radiation oncology, 2016

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

J Natl Med Assoc,

Ann Palliat Med,

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

International journal of radiation oncology, biology, physics, 1993-12-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2003-04-15

Cancer, 2011-06-15

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2015-09-20

The Lancet. Oncology, 2016-10

J Clin Oncol, 2018 Jan 18

Ann. Surg. Oncol., 2018 Oct 01

Clin. Orthop. Relat. Res.,

International journal of radiation oncology, biology, physics, 2015-08-01

American journal of clinical oncology, 2016-12

Int J Clin Exp Med, 2015 Sep 15

Pathol. Int.,

Oncotarget,

Radiother Oncol,

Cancer, 2010-10-01

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

American journal of clinical oncology, 2019-01

Annals of surgery, 2007-10

Annals of surgery, 2012-02

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2010-06

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

Br. J. Dermatol., 2014 Nov 10

Journal of the American Academy of Dermatology, 2018-11

Am. J. Surg. Pathol.,

Cancer,

Am. J. Surg. Pathol.,

Ann Diagn Pathol,

Practical radiation oncology, 2015

J Med Imaging Radiat Oncol, 2014 Apr 14

Clin. Cancer Res., 2020 Feb 13

Radiother Oncol, 2016 May 17

International journal of radiation oncology, biology, physics, 2009-07-01

International journal of radiation oncology, biology, physics, 2005-11-01

JAMA Oncol, 2020 Feb 20

International journal of radiation oncology, biology, physics, 2009-01-01

International journal of radiation oncology, biology, physics, 2011-07-01

Eur J Cancer,

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

Eur J Surg Oncol,

International journal of radiation oncology, biology, physics, 2002-02-01

Surgical oncology clinics of North America, 2013-07

International journal of radiation oncology, biology, physics, 1993-03-15

Sarcoma, 2014

Int. J. Radiat. Oncol. Biol. Phys., 2018 Aug 02

Lancet Oncol., 2017 May 09

Annals of surgery, 2016-05

Lancet Oncol., 2020 Sep 14

Ann. Surg.,

Annals of plastic surgery, 2013-12