huge lung metastasis with near lung collapse

[Kroll2013]

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Dear colleagues,

i need your opinion concerning this case.

23 yo patient with metastatic ovarian carcinoma that is presenting for dyspnea secondary to a huge lung lesion with a near collapsed lung and shifted heart and vessels to the midline.
can palliative radiation help?

 

[knuckles]

Quad shot

 

[medgator]

Maybe another option

Hypofractionated palliative radiotherapy (17 Gy per two fractions) in advanced non-small-cell lung carcinoma is comparable to standard fractionation for symptom control and survival: a national phase III trial - PubMed

Our data indicate that protracted palliative TRT renders no improvement in symptom relief, HRQOL, or survival when compared with short-term hypofractionated treatment in advanced NSCLC.

www.ncbi.nlm.nih.gov

I'd probably do 30/10 if pt in decent shape to the whole thing, otherwise 20/5 or 17/2.

 

[evilbooyaa]

30/10 to the part causing obstruction if too big to treat the whole thing. Also be very careful with collapsed lung as atelectasis can look a lot like tumor/lymphangiitic spread. I've seen ports where a relatively small tumor on axials with bronchial invasion/compression lead to the entire lower lobe getting radiation by those not discrening enough to differentiate tumor and atelectasis.

Newly diagnosed and has chemo options? 30/10 without a doubt to the obstructing part.

On 6th line chemo and transitioning to hospice? Consider 17/2 1 week apart like medgator or just do 8Gy x 1.