How does neoadjuvant chemo-immunotherapy impact your decision on hypofractionation/dose fractionation for locally advanced NSCLC, now getting RT alone?

If a patient has already received 3-4 months of a platinum-doublet chemotherapy during the chemo-immunotherapy phase, then it's always my preference to omit further chemotherapy and recommend RT alone. The rationale for this recommendation is that we don't administer additional chemotherapy to patie...

I still try for 60 Gy in 15 fractions if radiation alone, though I will dose adjust based on my OARs and at times underdose the PTV to maybe 52.5 Gy and try for 60 Gy to the ITV.

After a full course of neoadjuvant chemo‑immunotherapy, I would be cautious about increasing BED when treating locally advanced NSCLC with RT alone. Several observations from prior trials favor this approach.

In RTOG 0617, dose intensification did not improve outcomes and was associated with worse s...

I like the opportunity to give patients a break from systemic therapy, as I've never been convinced that temporary interruptions make all that much of a difference. Thus, I am a fan of RT alone and prefer to deliver it at 4 Gy/day. The key, though, is to never exceed the esophagus dose limits. Other...

I would base this decision on the extent of central disease and PTV overlap of the esophagus, favoring conventional fractionation in these cases (I would try for at least 66 Gy in 33 treatments with RT alone). The bulk of residual disease and history of pneumonitis would also be a factor, as you are...