How would you treat a bulky axillary squamous cell carcinoma of unknown primary in an elderly person?

70 Gy/ 35 fractions over 30-35 treatment days. Electively treat remainder of the axilla and supraclav to 56 Gy at 1.6 Gy per fraction SIB.

I have a patient exactly similar age, histology, stage, and unknown primary. He has a reduction of tumor size on PET from 7 to 3 cm after 3 cycles. He will start RT after the 4th cycle similar to fractionation mentioned in other answers.

If the patient can tolerate chemo, it would be strongly recom...

Chemo/RT...66-70 Gy to gross disease after conedown at 50/25 off the nearby supraclav/axillary lymphatics.

If it's larger than 3 cm, I'd consider concurrent chemo cisplatin 30-40 mg/m² weekly, or carbo/taxol during RT. If the patient has persistent/recurrent disease on post-tx PET, they may be a can...