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Topics:
Lung Cancer • Radiation Oncology • Thoracic Malignancies • Medical Oncology • Non-small cell lung cancer
Do you recommend concurrent or sequential radiation and chemotherapy for margin-positive, node negative NSCLC?
What factors influence your decision (R1 v. R2 resection? T stage?) If sequential, do you typically prefer radiation before or after chemotherapy?
Answer from: Radiation Oncologist at Academic Institution
We recently looked at outcomes with sequencing of PORT and chemotherapy in patients with pN2 disease and R0, or pN2 R1/R2 resection in the NCDB (J Clin Oncol 2017 Dec 13:JCO2017744771). This group is not exactly the pN0 patient population that is the focus of this question, however, in the R0 pN2 gr...
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Answer from: Radiation Oncologist at Academic Institution
I agree overall. The key here is, as Dr K points out, is that a positive margin is fairly rare for node negative patients. There's not any direct prospective data that addresses the question, so we're stuck extrapolating. We had a case recently and this is the way we approached it:...