How would you manage a patient treated with SBRT <1 year ago for a peripheral lung cancer who now has both mediastinal and local failure?

Presuming that the patient is inoperable due to the same reasons why the initial early stage disease was not managed surgically, given a peripherally placed primary, it likely can be retreated with SBRT, while minimizing chest wall and skin dose if at all possible. There shouldn't be an issue with r...

Breaking this question into its parts:

For patients who have ONLY a mediastinal failure, we have typically proceeded with definitive chemoRT and consolidation durvalumab (provided they are chemo candidates, which perhaps only half of our SBRT population is due to age/comorbidities/performances statu...

I agree with @Dr. First Last' response. This highlights the real need to appropriate stage patients who undergo SBRT for early stage lung cancers. That being said, in the real world, multiple factors may contribute to the lack of formal mediastinal staging and highlights the fact that imaging-based,...

Agree with everyone and their recommendations. In addition, we have some experience with percutaneous interstitial HDR brachytherapy in the treatment of radiorecurrent lung cancer after SBRT. We usually prescribe 24Gy in a single fraction but the D90 is always considerably higher.