How would you treat superior sulcus NSCLC with small volume N2 disease?

The question of surgery for N2 NSCLC patients in light of current survival and LC rates in the modern RT era with immunotherapy remains unclear. Historically, for these superior sulcus NSCLC patients, surgery played a large role due to our inability to deliver adequate dose of RT because of proximit...

In our center, we deliver 60Gy in 30 using VMAT with concurrent chemotherapy. The surgeons tell us they have no issues operating after delivering 60Gy, so I don't plan for 45Gy. Majority of the patients receive maintenance immune therapy, surgery is done in highly selected patients.

I have had issues with the typical preoperative approach for many years. The problem here is that, even in the best surgical hands, we expect a 20-25% R1 resection rate after pre-operative radiotherapy with a non-curative dose of 45Gy. At MDACC, we addressed this with a trial of postoperative treatm...