Questions discussed in this category
When, if ever, do you utilize adjuvant RT or chemotherapy?
S/P neoadjuvant chemotherapy and followed by oncologic surgical resection but with positive margins.
How do we approach patients with rare tumors given the paucity of data?
Would you consider using repretinib as first line therapy given its novel mechanism of action versus other treatment options?
Would you consider stopping therapy versus doxorubicin + dacarbazine/doxorubicin alone versus alternative chemotherapy ?
Sarcoma arose from Castleman disease
Would you prefer doxorubicin based chemotherapy or are alternative TKIs useful in this scenario?
Would non-gastric GISTs, high mitotic rate, large size, and young age of patient affect your decision? Especially knowing that TKIs suppress cell grow...
If so, which patients would you extend treatment?
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...
What role, if any, does molecular testing play in diagnosis and management in the absence of available clinical trials?
How would you add radiation in your treatment paradigm? No clinical trials available due to age.
Would your systemic therapy choice be more similar to treatment of ovarian carcinoma or soft tissue sarcoma?
If yes, would you offer neoadjuvant or adjuvant, concurrent or sequential?
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...
No evidence of distant disease elsewhere. Surgical resection is not possible. Would you recommend metastasis direct therapy to the liver (i.e. SBRT or...
Very rare tumor with sparse literature
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...
Pathology did not meet criteria for a well-differentiated nor dedifferentiated liposarcoma, nor a spindle cell sarcoma.
With conflicting data from the EORTC RCT and the Sarcoma meta-analysis collaboration, what factors determine when you would offer adjuvant chemotherap...
AD: doxorubicin + dacarbazine
AI: doxorubicin + ifosfamide
Does the degree of resectability affect your management?
How would you modify therapy for a younger, fit patient versus an older, frail patient?
Lesions in stomach, small intestine, colon resulting in bleed...
40 yo adult patient with a~6cm mass with concern for skull base bony involvement (group III and stage III, no nodal involvement )
Received optimal pre-op denosumab; only option is now amputation
What would be your radiation volumes/dose and choice of chemotherapy?
Would you offer adjuvant RT or chemotherapy? If so, what chemotherapy would you prefer?
AIM or doxorubicin/cisplatin? Would you recommend adding methotrexate?
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 factors make you more likely to offer or omit chemotherapy?
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...
Is chemoradiation a viable strategy in osteosarcoma?
Since desmoid tumors are associated with high estrogen states, is there an optimal contraception approach? Is there an optimal time for pregnancy? How...
Would you consider doing a pre-op RT prior to possible re-excision? If yes, what dose would you give? If the location is between L4-L5 spine.
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...
Do you switch to alternative TKI? Dose reduce?
Post-auricular cutaneous angiosarcoma, pT1 (19 mm) with negative margins. Unclear if there is any indication for systemic therapy, given early stage a...
Assuming no access to clinical trial
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...
> 7cm, grade 3. If chemotherapy offered, what is your preferred adjuvant therapy?
>10 cm, no metastatic disease identified on staging scans
How do you sequence systemic therapy with radiation and surgery?
For e.g. how many cycles of ifos/doxorubicin do you administer in this context?
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?
How does histology, time to distant Mets affect your decision?
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...
Potentially, if metastasis responds, could be treated with surgery or radiotherapy
Presented with mass projecting into right/left anterior ethmoid complex
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...
>5cm. If so, what is your preferred regimen?
Any strong considerations for infusional vs. bolus doxorubicin?
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...
Would you even consider trabectedin in this case given its cardiotoxicity?
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...
Do you proceed to resection or palliative chemotherapy?
How do you choose between single-agent or combination chemotherapy versus newer treatment strategies such as palbociclib?
How, if any, do you utilize genomic testing to guide systemic therapy?
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...
Do you reduce the dose to <400 mg daily or employ dosing schedules?
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?
How do you treat if adriamycin is not an option?
Specifically concurrent ifosfamide? Induction AIM?
Given metastatic disease and not a trial candidate, how would you approach this scenario? How does an underlying diagnosis of NF1 affect your decision...
NCCN suggests to consider continuation of imatinib from some single/multi institution non-randomized trials for ~2 years, but does not suggest what fa...
No actionable mutations were identified on next generation genomic sequencing.
How would you treat metastatic, unresectable, solitary fibrous tumor in a patient with mild hemophilia A? Each anti-VEGF medication comes with a warni...
Do you use chemotherapy or radiation?
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 a role for immunotherapy outside of trial setting?
Is there any data to suggest delayed initiation of adjuvant treatment would be beneficial? Or would close surveillance be reasonable? Patient is asymp...
Patient currently has bone and lung metastasis.
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.
Are there clinic trials that look promising for patients with leiomyosarcoma?
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The New England journal of medicine, 2018-12-20
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Cancer, 2011-11-01
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BMC Cancer, 2015 Oct 15
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British journal of haematology, 2017-08
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