Would you consider radiating an unresectable intimal sarcoma if it involved the valves of the great vessels?

First, I would quickly confirm that the patient is truly unresectable. I've seen complex cases deemed unresectable and therefore palliative at very fine institutions that were subsequently treated definitively after a second opinion at a center of peak surgical expertise. It is worth recognizing that the very best vascular and cardiothoracic teams are rarely going to be found in a cancer-specific hospital.

The initial approach, if unresectable, would likely be systemic unless cardiac function is already significantly compromised by the tumor. In that case, brief palliative XRT may be a consideration.

If warranted by good initial response to treatment and well-preserved functional status, I would offer consolidation with 60-66 Gy in 2 Gy fra...