What are indications for RT coverage of pleural cavity for margin positive resected Askin tumor after neoadjuvant chemotherapy?

Patients with malignant pleural effusion, pleural violation (2/2 chest tube placement through tumor) or pleural nodules at diagnosis should be considered for whole-pleural surface RT at the time of local RT to the chest wall.

Of note, patients w/out + margins would also be considered for whole pleural surface RT if the above indications/criteria are met, although the timing would be different and consolidative RT would be given at the end of consolidation chemotherapy.

IMRT is generally required for coverage of the pleural surface akin to what would be done for an adult mesothelioma, but protons are being developed for use by some groups/sites, and may have the potential to reduce heart and lung dose.

The use of electrons and/or brachythe...