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Radiation Oncology • Thoracic Malignancies
How would you design PORT volumes for a patient with NSCLC and positive chest wall margin?
After sublobar resection and well dissected mediastinum, would you soley focus on the area of the positive margin or would you include ipsilateral hilar and/or mediastinal irradiation as well?
Answer from: Radiation Oncologist at Academic Institution
A positive surgical margin (bronchial, vascular, parenchymal) after a typical lobectomy/pneumonectomy for NSCLC is rare (~1-2%- JTO 2015;10:1625), a bit higher after sublobar resection, and even higher after chest wall resection (14% in our series- Tandberg et al. Clin Lung Cancer 2016). The most ac...
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Answer from: Radiation Oncologist at Academic Institution
Pathologists will often report a "visceral pleural margin". This is not a true surgical margin (as opposed to the bronchial, vascular, and parenchymal margins), and in the absence of pathological documentation of invasion into the parietal pleural (chest wall), I believe one can simply ignore this a...
Answer from: Radiation Oncologist at Academic Institution
Could we rephrase the question? How would we design PORT volumes when there is invasion into the parietal pleura (e.g. chest wall)? I have received several consultations for patients with the pathology report describing a positive visceral pleural margin. However, when I reviewed the slides with pat...