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Topics:
Radiation Oncology • Thoracic Malignancies
How does neoadjuvant chemo-immunotherapy impact your decision on hypofractionation/dose fractionation for locally advanced NSCLC, now getting RT alone?
Is 60 Gy/15 fx appropriate? Is there a volume PTV cut-off (cc) which would switch to a more fractionated approach (e.g., 60 Gy/30 fx)? Is there an area you would dose reduce (e.g., hilum or mediastinum) after neoadjuvant chemo-immunotherapy?
Answer from: Radiation Oncologist at Community Practice
If the patient is fit enough for surgery, they will likely be fine with 60/15, as long as you can keep the esophagus below 45/15. If you can't, or if the patient is frail, then phase III data tell us it's safer to go with 60/30 with RT alone.Ref: Iyengar et al., PMID 34383006.
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Answer from: Radiation Oncologist at Academic Institution
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.