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How do you approach at-risk draining nodes and the bronchial stump in PORT volumes for margin-positive, pN0 NSCLC?

NCCN guidelines as of the May 2021 update state "In PORT, the CTV includes the bronchial stump and high-risk draining lymph nodes stations." Would you now only irradiate the +margin region while omitting PORT to the bronchial stump (if not the +margin site) & at-risk nodes?
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Radiation Oncology · Mayo Clinic Florida
Answered on

For a positive-margin, pN0 NSCLC, I would only treat the positive margin region. In a pN0 patient, there would be no benefit to treating the mediastinum prophylactically and there is certainly no evidence for this. One could perhaps make an argument for prophylactically treating regional LNs if the ...

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