clinical cases

[gutonc]

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As an anaesthesiologist/intensivist I have no oncological input into this fascinating and impressive thread (hats off to your breadth of knowledge), but that has to be the most brain dead airway plan I’ve ever heard of.

I have seen airway centered lesions temporarily swell after immunotherapy administration more than once so you either secure the airway early or not at all. The path suggested by ENT is a recipe for a horrible middle of the night death due to an airway that can’t be secured.

When ENT says they can't secure an airway, hospice is the only answer. And a palliative trach will result in less morbidity than the emergent one they'd have to do at 3am on a Sunday when the airway goes to s***. Because it never happens at 11am on a Tuesday.

 

[ONC2023]

Have a really strange/tough sarcoma case.

31 year old.

Right leg periosteal sarcoma, low grade, MDM2+, resected years ago. No chemo or RT given.

Now, 4 years since his surgery, had a left lung mass that takes up nearly 80% of the hemithorax -- biopsy shows MDM2+ sarcoma consistent with a periosteal sarcoma. I spoke with pathology who think it remains low-grade -- the biopsy specimen shows no high grade features, but again, it may have been sampled at a non-representative spot.

Surgery does not think they can resect it.

Rad onc does not think it is radiosensitive.

So here's my dilemma: I have an ostensibly low-grade periosteal sarcoma in the lung that takes up 80% of the hemithorax that cannot be resected or radiated. Also, low-grade periosteal sarcomas are apparently not chemosensitive.

What do I do? Assume it's high-grade and give MAP? Accept it's low-grade and give MAP anyways because I have no other options? NGS is pending.

If it's metastatic, isn't that the tell that it's not "low-grade" anymore and appropriate for MAP? I am leaning towards that.

 

[HemeOncHopeful19]

31yo with recurrent sarcoma in 80% of their lung? Are you in the ivory tower and if not how far away is the closest one?

 

[ONC2023]

31yo with recurrent sarcoma in 80% of their lung? Are you in the ivory tower and if not how far away is the closest one?

Hah - you read my mind. I am not in academics but have already started referral to the most ivory of towers.

My instinct is to honestly delay treatment and let an expert center manage it, but I need to make sure they can actually get there in a reasonable time frame. I'm mostly thinking of MAP as a temporizing measure.

 

[gutonc]

Hah - you read my mind. I am not in academics but have already started referral to the most ivory of towers.

My instinct is to honestly delay treatment and let an expert center manage it, but I need to make sure they can actually get there in a reasonable time frame. I'm mostly thinking of MAP as a temporizing measure.

I trained in a sarcoma center and I don't touch this s*** ever. Ship it. Today.