Non seminoma radiation therapy dose

[bonusking]

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Hello everybody,

What is the required dose for a non seminoma testicular tumor (Embryonary carcinoma and extention to the yolk bag) (IIC s2, intermediary risk)?

The patient benefited from surgery with an inoperable inter aorto-cave residue followed by three lines of chemotherapy.

The chemotherapy didn't influence the residue, and there is no other lesions.

I plan to treat with tomotherapy the inter aorto cave residue with 60 gy en 30 fractions.

Thanks in advance.

 

[RickyScott]

Hello everybody,

What is the required dose for a non seminoma testicular tumor (Embryonary carcinoma and extention to the yolk bag) (IIC s2, intermediary risk)?

The patient benefited from surgery with an inoperable inter aorto-cave residue followed by three lines of chemotherapy.

The chemotherapy didn't influence the residue, and there is no other lesions.

I plan to treat with tomotherapy the inter aorto cave residue with 60 gy en 30 fractions.

Thanks in advance.

Seems reasonable.

 

[bonusking]

Seems reasonable.

Do you have any experience with similar case, also the patient is 14 years old.

 

[RickyScott]

Do you have any experience with similar case, also the patient is 14 years old.

In training in an older pt we took the ptv to bowel tolerance. Given his age, it is worth calling the guy at at Indiana (Einhorn?) or someone at mass general.

 

[evilbooyaa]

Treating to bowel tolerance seems reasonable. Agree with checking in with peds GCT rad oncs (super subspecialized cohort).

 

[Palex80]

Depending on the size of the lesion, one could also opt for SBRT perhaps?

But 60/2 is certainly fine.

 

[radtothebone]

Hello everybody,

What is the required dose for a non seminoma testicular tumor (Embryonary carcinoma and extention to the yolk bag) (IIC s2, intermediary risk)?

The patient benefited from surgery with an inoperable inter aorto-cave residue followed by three lines of chemotherapy.

The chemotherapy didn't influence the residue, and there is no other lesions.

I plan to treat with tomotherapy the inter aorto cave residue with 60 gy en 30 fractions.

Thanks in advance.

Refer to another surgeon. These can be very challenging cases, but almost all are resectable (sometimes requiring vascular reconstruction). The rationale for surgery over XRT is the possibility of residual teratoma. This will likely not be affected by the doses you are planning and runs the risk of transforming to a somatic malignancy.

 

[DoctwoB]

Hello everybody,

What is the required dose for a non seminoma testicular tumor (Embryonary carcinoma and extention to the yolk bag) (IIC s2, intermediary risk)?

The patient benefited from surgery with an inoperable inter aorto-cave residue followed by three lines of chemotherapy.

The chemotherapy didn't influence the residue, and there is no other lesions.

I plan to treat with tomotherapy the inter aorto cave residue with 60 gy en 30 fractions.

Thanks in advance.

Urologist weighing in here. I second the opinion of finding another surgeon. This almost certainly represents residual teratoma and won't benefit from chemo or radiation. As the above poster mentioned, it is quite rare for them to be truly unresectable, but it may require a heroic effort with vascular reconstruction. While I am generally not a fan of over-centralization of most procedures, this is something I would consider referring to MSKCC or Indiana (two highest volume RPLND centers) if family is willing to travel.

One issue that often comes up with these patients is they are treated by pediatric urologists because they are kids, but have a problem that is more suited to be managed by adult urologic oncologists. Smart peds urologists will bring in their adult colleagues to help or refer the case, but some won't. If urologic oncology at a high volume RPLND center says its truly inoperable, then I'd consider radiation as a hail mary, but not before.

 

[Chartreuse Wombat]

Agree with recent posters. The residual mass is likely teratoma and the next step is high volume surgeon

 

[thecarbonionangle]

Agree with surgery if possible. If not would treat to at least 54gy

 

[Neuronix]

Your administrator here at the NSA chiming in again that referrals are likely not possible in this case...