How do you approach a NSCLC case with extensive nodal disease that results in a radiation plan that cannot meet normal tissue constraints?

Topics: Radiation Oncology • Thoracic Malignancies

When treating a NSCLC with extensive bilateral mediastinal disease +/- supraclavicular nodes, would you recommend exceeding certain tissue constrains such as lung, heart, or esophagus? Or dropping the total dose? Decreasing your CTV/PTV margins? Neoadjuvant chemotherapy would likely not help as the involved nodal stations will be treated regardless of chemotherapy response.

Answer from: Radiation Oncologist at Academic Institution

This is an interesting question as there are multiple, complementary approaches that can be taken: If using > 60 Gy, drop the dose down to 60 Gy in 2 Gy fractions. Some practitioners continue to use > 60 Gy in the post-RTOG 0617 era, which is not unreasonable based on retrospective data and f...

Comments

Radiation Oncologist at Angelina Radiation Oncology Associates
Of course, the unspoken alternative is to recogniz...

Answer from: Radiation Oncologist at Community Practice

One can consider neoadjuvant chemo (debulk) or protons.

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Radiation Oncologist at UCLA | VA Greater Los Angeles Healthcare System
Agree. Treat with a stage IV regimen and come back...

Radiation Oncologist at MUSC Health of Medical University of South Carolina
Is there any prospective data to guide this approa...

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