oligomet renal cell
Started by RickyScott
A renal cell metastasized to base of tongue??
Nephrectomy 10 yrs ago. Wedged a lung met 2 yrs ago, and bot mass one year ago, initially near complete response but then progressed on Sutent. Only site of disease on pet.
are you sure the BOT is from RCC? that does not make sense.
and even if it was RCC in the BOT i would not SBRT it. I would do something like 55/20.
but yeah, 5 cm RCC met to the BOT? wtf?
and even if it was RCC in the BOT i would not SBRT it. I would do something like 55/20.
but yeah, 5 cm RCC met to the BOT? wtf?
Path reviewed at academic ctr and Initial near complete response to sutent.
35 up to 40/5 if you're going to treat this more radioresistant histology. Patient will get bad mucositis for a few weeks after RT that you need to warn them about. Small risk of putting a hole in it (heard about holes in palates with 50/5). Will probably want to let your local ENTs know what you're doing in case they have to deal with an urgent/emergent situation as a result.
Have not looked up pharyngeal constrictor constraints with SBRT which is likely the biggest concern given location.
Cancer does weird **** sometimes.
Good luck!
Have not looked up pharyngeal constrictor constraints with SBRT which is likely the biggest concern given location.
Cancer does weird **** sometimes.
Good luck!
RCC certainly does weird things. There appear to be a handful of case reports, though mainly oral tongue.
I've never seen SBRT for a H+N primary that has not been radiated before, and I'd be reluctant to give SBRT. He could still live years with systemic treatments, and the idea of giving SBRT to a large area of the BOT and surrounding mucosa/musculature scares me.
Agree with 55/20 for a solid palliative dose. Just my two cents.
I've never seen SBRT for a H+N primary that has not been radiated before, and I'd be reluctant to give SBRT. He could still live years with systemic treatments, and the idea of giving SBRT to a large area of the BOT and surrounding mucosa/musculature scares me.
Agree with 55/20 for a solid palliative dose. Just my two cents.
Found this to base treatment on. Seems like they were quite aggressive. Thinking 8-9 gy x 4
Difference between localized cancer and metastatic RCC, even if it's oligo met.
Also, difference (in the other way) of sensitivity of SCC vs RCC.
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Agreed. Really don’t see the rationale for SBRT where your target IS mucosa. Usually we SBRT and try to avoid mucosa. You’re asking for trouble
I guess the idea is that renal like melanoma may benefit from hypofrac either because low alpha beta or because sbrt is immunogenic.
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I agree with hypofrac but not SBRT. I think 55/20 is good too
would not SBRT just Bc you’ve been lead to believe its “radioresistant.” (It had a near complete response to sutent? That already says something funny about the biology). You’ll never know if it was the right thing to do, like you’ll have very little barometer if it was in hindsight and you’re risking significant toxicity with incomplete response.
D
deleted1002574
SbRT would be extremely dangerous in this setting. You will mess this person up or have a high risk of doing so. Absolutely do not put yourself in medicolegal jeopardy here. 55/20, 70/35 are reasonable. This is potentially curable, but at the same time, people can live a long time with RCC. Don’t put a hole in their tongue.
ambivalent here. what do you think chances 55/20 or 75/30 will cure him. hpv- Head and neck which is supposedly more readiosensitive would have less 20% local control with XRT only.
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What makes you so special to make this assertion? Do you know the cancer personally?
Had an old attending who used to say "Sometimes these tumors don't read the textbook."
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Weird place for a RCC met!
Seems like a good case for brachytherapy, if there is someone with expertise.
If no surgical option and brachy isn’t available, I would offer definitive 5-10 fx sbrt-like treatment (i.e 8 Gy x 5, or 6 Gy x 7-8) or offer a straight palliative treatment... Would explain the risks and let them make the choice between the two. I always frame the issue in these sorts of cases by asking them “are you the sort of person who will stay up at night worrying about the tumor coming back, or are you the sort of person who will stay up at night worrying about the chance of bad toxicity?”
edit: I just re-read case and saw size of 5 cm (for some reason I was picturing it smaller). Would probably back off dose into the 7Gy x 5 range, if definitive treatment is pursued.
Seems like a good case for brachytherapy, if there is someone with expertise.
If no surgical option and brachy isn’t available, I would offer definitive 5-10 fx sbrt-like treatment (i.e 8 Gy x 5, or 6 Gy x 7-8) or offer a straight palliative treatment... Would explain the risks and let them make the choice between the two. I always frame the issue in these sorts of cases by asking them “are you the sort of person who will stay up at night worrying about the tumor coming back, or are you the sort of person who will stay up at night worrying about the chance of bad toxicity?”
edit: I just re-read case and saw size of 5 cm (for some reason I was picturing it smaller). Would probably back off dose into the 7Gy x 5 range, if definitive treatment is pursued.
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