In LS-SCLC, for a patient with positive mediastinal LN but PET negative ipsilateral hilum, would you treat the hilum?

I generally agree with Dr. @Dr. First Last, however, it would depend on the location of the primary tumor. If the dose to the primary treated part of the hilum, I would treat the hilum more comprehensively. This just because it would be so difficult to go back should the tumor fail there. I agree th...

No. With PET staging, there is a low rate of isolated nodal failure and at this point in time, I would only treat the positive areas. A prospective study from the Dutch studied this and found just 3% failure rate.

That being said, elective nodal irradiation with more conformal fields (VMAT) may not ...

It's rare for SCLC to not involve the hilum somehow. For example, I would feel uneasy skipping the negative hilum for a central-ish tumor with Lv 4 involved. In the 3D era, the hilum for sure got dosed, and it's counterintuitive to intentionally cool down the hilum with IMRT when the tumor most like...

Playing a bit of devil's advocate in favor of not electively covering (nor purposely avoiding) the ipsilateral hilar region, a couple of additional points to consider, though by no means authoritative guideline:

- Direct lung parenchyma-to-mediastinal lymphatic drainage patterns, bypassing the hilar ...

The recently published "High-dose versus standard-dose twice-daily thoracic radiotherapy for patients with LSSCLC: an open label, randomized, phase 2 trial" (Grønberg et al., PMID 33662285) is, to me, the most significant publication regarding radiation therapy for this disease recently. They treate...