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Topics:
Radiation Oncology • Thoracic Malignancies • Medical Oncology • Thoracic Surgery • Non-small cell lung cancer
Do you ever recommend PORT or chemoRT rather than chemotherapy alone for NSCLC with adverse features other than positive margins or N2 disease?
For example, would a + vascular margin, extranodal extension of N1 disease, translobar disease, or high risk histologies (large cell neuroendocrine, spindle cell, sarcomatoid, etc) lead you to recommend PORT?
Guidelines endorse chemotherapy alone for N0-1 disease and chemoRT for N2 disease or positive margin but some cases fall in between with no clear data to guide us.
Answer from: Radiation Oncologist at Academic Institution
Despite the numerous limitations of the PORT meta-analysis, and subsequent non-randomized studies of postoperative RT in NSCLC, one message seems clear (at least to me)- radiation therapy can cause harm. In patients with resected lung cancer (who often have many co-morbidities), prudence seems a wis...
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Answer from: Radiation Oncologist at Academic Institution
I agree completely with @Christopher R. Kelsey. The only other group that could be considered for PORT is the rare patient that had involved hilar nodes and inadequate surgery in the mediastinum. I’ve seen cases where the procedure needed to be halted for medical reasons before the media...