Would you offer preoperative radiation for an intrathoracic leiomyosarcoma in the posterior mediastinum?

I would want further details (age, grade, size, specific anatomic relationships, etc), but most likely yes.

DOSE AND FIELD: I would typically treat GTV + 1.5 cm anatomically constrained expansion to 50.4/28, plus any suspicious edema on T2 STIR. By analogy with retroperitoneal sarcomas, I think one could consider SIB (57.4-63 Gy) to areas of anticipated close/positive margin delineated in cooperation with the surgeon.

EFFICACY: I'm not aware of much data about this scenario specifically. However, based on first principles, this anatomically challenging location is likely to lead to close or positive margins as well as risk a non-en bloc resection/intraop tumor spill. Therefore, the LR risk is likely significant. Moreover, salvage options fo...