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I have a very young adult patient with a large high-grade sarcoma of his extremity with extension into the pelvis. He underwent staging studies which showed a large > 15 cm mass without evidence of mets. He had a massive surgery at our local academic center which involved femoral artery bypass and abdominal wall reconstruction. 18.5 cm, high grade synovial sarcoma with negative margins.
> 2 month delay to XRT start due to wound dehiscence and healing issues. To r/o mets I went ahead and got a PET/CT simulation and . . . it doesn't look good.
He has a very large ~12 cm local recurrence with a couple of abdominal wall mets near the surgical incision sites. Symptomatically, he has pain in R pelvis area probably due in part to bony destruction from recurrence. Obviously, things are very bleak but I'm curious what people would do? Options include:
1. Referral to hospice
2. Send patient for chemo and hope he has a response
3. XRT for palliation (perhaps hypofractionated) to large local recurrence followed by chemo
4. ? ChemoXRT - I will have to discuss this with our local academic sarcoma experts
Input appreciated.
> 2 month delay to XRT start due to wound dehiscence and healing issues. To r/o mets I went ahead and got a PET/CT simulation and . . . it doesn't look good.
He has a very large ~12 cm local recurrence with a couple of abdominal wall mets near the surgical incision sites. Symptomatically, he has pain in R pelvis area probably due in part to bony destruction from recurrence. Obviously, things are very bleak but I'm curious what people would do? Options include:
1. Referral to hospice
2. Send patient for chemo and hope he has a response
3. XRT for palliation (perhaps hypofractionated) to large local recurrence followed by chemo
4. ? ChemoXRT - I will have to discuss this with our local academic sarcoma experts
Input appreciated.