How would you treat a bulky axillary squamous cell carcinoma of unknown primary in an elderly person?

Assuming no other sites of disease on staging scans, surgery is not an option, and the patient is otherwise healthy with reasonable life expectancy. What dose-fractionation would you use? Would you cover any elective nodal basins beyond gross disease?

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To what total dose would you treat unresectable bulky axillary SCC of unknown primary?

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3 Answers

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Radiation Oncology · University of Florida

Answered on

70 Gy/ 35 fractions over 30-35 treatment days. Electively treat remainder of the axilla and supraclav to 56 Gy at 1.6 Gy per fraction SIB.

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Radiation Oncology · Community Care Physicians

Answered on

I have a patient exactly similar age, histology, stage, and unknown primary. He has a reduction of tumor size on PET from 7 to 3 cm after 3 cycles. He will start RT after the 4th cycle similar to fractionation mentioned in other answers.

If the patient can tolerate chemo, it would be strongly recom...

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Radiation Oncology · Cancer Care Centers of Brevard

Answered on

Chemo/RT...66-70 Gy to gross disease after conedown at 50/25 off the nearby supraclav/axillary lymphatics.

If it's larger than 3 cm, I'd consider concurrent chemo cisplatin 30-40 mg/m² weekly, or carbo/taxol during RT. If the patient has persistent/recurrent disease on post-tx PET, they may be a can...

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