Would you offer radiation for Stage III NSCLC in a non-surgical candidate with prior post-mastectomy chest wall RT?

Yes, I would offer definitive thoracic radiation (60 Gy standard fractionated) to a patient with prior h/o postmastectomy chest wall radiation, even if the lung cancer is on the same side as the irradiated chest wall. Likely the dose to the chest wall was around 50 Gy. If there were any areas of chest wall which received a higher dose (such as possibly the mastectomy scar), it would be prudent to avoid these regions while applying VMAT IMRT for the treatment of lung tumor. Since VMAT distributes radiation dose along the path of an arc, no part of the chest wall should receive the excessive dose.

Of course, the records of post-mastectomy RT may not be available after 20 years, but sometimes physical examination may give clues about any RT bo...