Do you routinely order a thoracic or brachial plexus MRI for patients with apical lung cancers?

For patients with superior sulcus tumors (or apical lung tumors), their clinical presentation usually drives the choices of imaging modality. In my experience, if a patient has an apical tumor and presents with no symptoms at all, then I would not see the utility or need to require MRI imaging, unless there were a very specific historical context that would trigger that need (e.g. reirradiation perhaps). Any patient with any symptoms attributable to a local effect from tumor being in the apex, w...

Yes. Superior sulcus malignancies, by definition, are either clinical T3 (invading the chest wall) or T4 (invading mediastinal structures, including the vertebrae and brachial plexus). Therefore, an MRI of the thoracic inlet is a standard recommendation in the evaluation of all such patients at the initial time of treatment planning and also before surgical resection following neoadjuvant therapy. In S1934, the ongoing superior sulcus trial of trimodality therapy +/- Atezolizumab, patients are r...