Would you consider omission of PORT for node+ NSCLC with a positive margin in the setting of a high tumor PD-L1 score and plans for immunotherapy?

For gross positive margins (R2), no, adjuvant chemoRT followed by consolidation immunotherapy.

For R1, SOC would still say PORT and adjuvant systemic therapy. But let's try to tease it out in a more nuanced way from available data. First PD-L1 high is certainly a check in the plus column for a clinical benefit of adjuvant immunotherapy. The benefit of adjuvant atezolizumab after resection and adjuvant chemotherapy in patients with stage II-IIIA NSCLC was observed only in PD-L1 high (>=50%) subse...

For T1abc–T2aN1, T2bN1, and T3, N0 disease, patients with negative surgical margins (R0) and appropriate biomarkers adjuvant chemotherapy (category 1) followed by atezolizumab, pembrolizumab, or osimertinib is recommended. (Pignon et al., PMID 18506026), (NSCLC Meta-analyses Collaborative Group, PMID 20338627), (NCCN Guidelines Version 5.2024 Non-Small Cell Lung Cancer) If surgical margins are positive in these patients, options after an R1 resection include re-resection and chemotherapy or chem...