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

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 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 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...

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...