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Radiation Oncology • Melanoma/Skin Cancer
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?
Answer from: Radiation Oncologist at Academic Institution
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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Answer from: Radiation Oncologist at Community Practice
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...
Answer from: Radiation Oncologist at Community Practice
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...