How would you treat an endobronchial NSCLC abutting a hiatal hernia in a patient who is medically inoperable?

Topics: Radiation Oncology • Thoracic Malignancies • Non-small cell lung cancer

Answer from: Radiation Oncologist at Academic Institution

Rates of G5 toxicity (hemorrhage primarily) with even 8 fraction SBRT from the HILUS trial are unacceptably high. The hiatal hernia adds another layer of complexity and the increased risk for tox with stereotactic approaches. If the patient can get chemo, I’d favor concurrent conventionally fr...

Comments

Radiation Oncologist at Mon Health
For the non-chemotherapy candidate, what are your ...

Radiation Oncologist at Vanderbilt-Ingram Cancer Center
@James, I think that’s reasonable as well. I...

Radiation Oncologist at Mon Health
I have used the 15 fraction constraints. Thanks ve...

Answer from: Radiation Oncologist at Community Practice

If it's a large lesion invading the mediastinum or other bad disease, I'd probably just use IMRT to 60 Gy c concurrent chemo at standard fractionation. OTOH, if it was a smaller lesion, and/or the patient couldn't tolerate chemotherapy, I'd probably use an SBRT plan c breath hold treating the cente...

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