How would you palliate a large, symptomatic vaginal melanoma recurrence with limited small pelvic lymph node metastases?
Would your management change given that this recurrent lesion is over 10 cm and the patient previously achieved complete response on immunotherapy 5 years ago?
Answer from: Medical Oncologist at Academic Institution
In the event of recurrence, pre-treatment workup should include a full body PET scan and MRI brain with and without contrast to look for a sanctuary site in the brain. It goes without saying that a clinical trial would be ideal for a patient like this. In the absence of a clinical trial, there are t...
Comments
Radiation Oncologist at Allegheny Health Network Given the radio-resistant nature, I would use eith...
Vaginal melanoma is very difficult to resect without exenterative procedures. And I would not resect if bladder and/or rectal resection is needed. Would re-treat with IO (dual vs single agent is debated). We would also discuss hypofractionated RT to pelvis and with that give single agent pembro. We ...
Comments
Medical Oncologist at University Hospitals I would be careful with the IO-RT combination. The...
Answer from: Radiation Oncologist at Academic Institution
Palliation. Treat problems that are symptomatic. No expensive systemic work up. Pall RT to the pelvis if it’s symptomatic. 30 Gy/10 fractions, 25 Gy/5 fractions, or 20 Gy/2 fractions with a 1 week inter-fraction interval. Apologize for the lengthy response.
Comments
Medical Oncologist at University Hospitals I apologize, but I humbly disagree with this appro...
Given the radio-resistant nature, I would use eith...