Would you ever consider treating a patient with locally advanced NSCLC with SBRT to the primary tumor plus conventional mediastinal chemoradiation?

I have used the technique when the primary is far away, and conventional techniques would give a large PTV on the primary due to respiratory motion. Options in that case would include breath hold, abdominal compression, or phase gating for all 30 fractions of a conventional plan, or treating the med...

I would await the results of LU008 before doing this off-trial. The Phase 2 results from Heinzerling et al., PMID 39615497, that supported the development of LU008 statistically failed to meet its primary endpoint of >60% 1 year PFS (although it was likely just underpowered at 61 patients), but more...

I am comfortable using this approach whenever the primary tumor is above or below the transaxial planes of the CRT field, and the SBRT plan meets standard SBRT constraints for stage I NSCLC. My preference is to deliver 30 Gy x 1 on the Thursday or Friday before the week before CRT begins, and move t...

I have used this approach off protocol in select cases, particularly when the primary tumor is well separated from the involved nodes. That said, for any similar cases that I encounter now, I try to enroll patients on LU008 when appropriate.

For cases where the primary is far removed from the involv...

We have done these on very few occasions, but always based on VQ scan and PFT data.

If using traditional fields would compromise a patient's already poor pulmonary status, the use of "separate" fields is very reasonable, along with the mentioned dose constraints.