How do you approach a NSCLC case with extensive nodal disease that results in a radiation plan that cannot meet normal tissue constraints?

This is an interesting question as there are multiple, complementary approaches that can be taken:

• If using > 60 Gy, drop the dose down to 60 Gy in 2 Gy fractions. Some practitioners continue to use > 60 Gy in the post-RTOG 0617 era, which is not unreasonable based on retrospective data and first pr...

One can consider neoadjuvant chemo (debulk) or protons.