Would you offer SBRT/hypofractionation for stage I NSCLC with positive margins after resection?
Assuming re-resection is not feasible. The NCCN guidelines for post-operative RT for Stage I lung cancer with positive margins is PORT to 54-60 Gy (in event re-resection is not feasible). It seems unfavorable to have to treat such a patient for 6 weeks when the same patient could have gotten SBRT in <= 5 fractions without surgery. Would you consider treating such a patient with hypofractionated course of RT like 48 gy in 12 fractions or SBRT?
Answer from: Radiation Oncologist at Academic Institution
I agree that this is a tough situation. Although the ACOSOG trial showed no difference in LR statistically, it did decrease the crude failure rate. That being said, our surgeons feel uncomfortable observing this group of patients. From a practical standpoint, many of these patients have medical i...
Answer from: Radiation Oncologist at Community Practice
As one of the co-authors of ACOSOG Z4032, I agree that focally-directed therapy (it doesn't get any more focal than brachytherapy) did not pan out to be beneficial despite our institutional experience at the time which formed the basis for the ACOSOG trial. I don't think the state of the literature ...
The issue here is really target volumes. Often st...
Thanks for the helpful comments. So, in the event ...