Intent of treatment: PALLIATIVE
(cannot cure this chap)
High dose Pall RT for symptom control is reasonable :- In view of young age, and if relatively good PS
Dose determined by what you think is safe :-
Organs at Risk: Brain Stem, Spinal Cord, Brain , Eyes, Pituitary etc
I hope you wont offer IMRT, but some simple 3DCRT.
(Understanding the limitation of newer technology and you ability to make a difference between radical doses and palliative doses)
PTV = 1.5 -2 cm margin
you may have to be tight at the spinal cord inferiorly
Max dose you can go for will be 48-50 Gy ( Spinal cord TD 5/5 ) - accepting a slightly higher risk.
We recently treated a Recurrent chordoma of the spine at D5-6 - we went upto 50 Gy, explaining the risk to the pt.
If you want to be more conservative and be safer settle for 46 Gy.
If you want chemo, in adjuvant setting —-
Single agent Doxorubicin gives response rates : 25-30%
Combination Chemo Doxorubicin + Ifosphamide : upto 40% response rate.
We usually go for the RT option first and then wait for him —-> to relapse locally or systemically
and then prefer to go for Palliative chemo option. (delayed chemo rather than offer them early).
Young pts go for combination
Older, less fit ones go for single agent.
Majority of pts fail / progress ( > 60%)
Second line chemo : Trabectidin (Yondelis) licensed for sarcomas
Cheers
Rohit
