Topics:
Radiation Oncology • Thoracic Malignancies
How would you approach a mediastinal-only presentation of squamous cell carcinoma of the lung s/p lymph node biopsy consistent with lung origin, with PET positive for only mediastinal disease?
What would be you field and margins?
Answer from: Radiation Oncologist at Academic Institution
First, I would confirm no prior cancer diagnosis, review in detail with a multidisciplinary tumor board, and try to rule out the non-lung primary site. If no primary can be found, and PET demonstrates limited disease only in the mediastinum/hilum, then I would just treat the disease that you can see...
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Answer from: Radiation Oncologist at Community Practice
If the patient is eligible for chemotherapy, I would strongly favor concurrent chemoradiation to 60Gy/30fx. The "one size fits all" involved-nodal-type approach for NSCLC volumes from our specialty frustrates me and I hope we eventually re-evaluate the potential benefit of elective nodal RT, but for...
Comments
Radiation Oncologist at Mallory Radiotherapy, PLLC
Hey @Ryan T. Jones, If getting chemo, you are adv...
Hey @Ryan T. Jones, If getting chemo, you are adv...
Radiation Oncologist at Tennessee Oncology
@Matthew L. Mallory! Has been too long. I hope you...
@Matthew L. Mallory! Has been too long. I hope you...
Answer from: Radiation Oncologist at Academic Institution
I agree with definitive concurrent chemoRT limited to the FDG-avid disease if no primary lesion is identifiable. T0N2 NSCLC is an entity that our group has described and seems to have relatively favorable outcomes with definitive RT. (Romesser et al., PMID 30642548). Subsequent NCBD analysis also su...