Sarcoma Flashcards
First line treatment of localised leiomyosarcomas?
Surgical resection without adjuvant RT or systemic therapy despite high rate of recurrence.
First line treatment of localised soft tissue sarcomas?
Surgical resection with pre- or post-operative RT.
First line management of Ewings sarcoma?
Alternating neoadjuvant dose dense VDC (vincristine, doxorubicin and cyclophosphamide) and IE (ifosfomide, etoposide) with mid treatment surgery and radiotherapy.
What is defined as a good response in pathology at resection in Ewings and osteosarcomas?
Tumour with 90% necrosis or <10% viable tumour in specimen
Which site of oligometastatic disease confers better prognosis?
Lung
What is the management of angiosarcomas?
Can be treated with radical surgery but relapse rates are high. Systemic treatment with paclitaxel gives the highest response rates.
How would you manage high methotrexate levels?
Increase dose of leucovorin (folinic acid). If in AKI use glucarpidase to reduce MTX levels.
Which medications should be avoided alongside high dose methotrexate
NSAID, penicillin, sulphonamides and PPI (when possible).
Which mutations are commonly associated with GIST?
CKIT and PDGFRA
How does treatment of non-resectable GIST change in the presence of a KIT exon 9 mutation?
Confers worse prognosis therefore consider imatinib 400mg BD rather than OD.
What is adjuvant treatment for GIST?
3 year of adjuvant imatinib
What treatment is used for recurrent/metastatic GIST?
Imatinib 400mg OD, in second line use Sunitinib
Best validated prognostic factors for GIST?
Mitotic rate, tumour size and tumour site
Which chemotherapy drugs are associated with a high risk of infertility in male patients?
Cyclophosphamide and platinum agents.
When does ifosfamide induced encephalopathy usually present?
Within 12 to 48hrs
