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Radiation Oncology • Thoracic Malignancies
How would you manage a recurrent mediastinal node 2 years after 45Gy BID to this region with combined chemotherapy for SCLC in patient no longer tolerating systemic therapy?
Answer from: Radiation Oncologist at Academic Institution
If comprehensive restaging (PET, Chest CT with IV contrast, brain MRI) demonstrated a single biopsy proven nodal recurrence 2 years after standard chemo-XRT, I would retreat the patient. The critical structures are likely to be the trachea (tolerance dose ~90Gy) and the esophagus. There ...
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Answer from: Radiation Oncologist at Community Practice
I agree with Dr Stevens. With nodal relapse in a 45 Gy BID field, late recurrence suggest need for more powerful fraction size and dose. I like 3Gyx15. Similar case with 2 yr relapse bx + at primary. Chemo was started, but either SBRT or hypoFx. just to 4D defined target is my solution to isolated l...