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Radiation Oncology • Thoracic Malignancies
When would you include uninvolved nodal stations when treating patients with locally advanced NSCLC with definitive CRT?
Although elective nodal irradiation is not standard, what you treat lymph node stations that are adjacent to involved lymph nodes? For example, in a patient with a RUL primary tumor and lower right paratracheal involved lymph nodes (abutting but not in the subcarinal space) and right hilar involved lymph nodes, would you include level 7 in your treatment volume? Would it get full dose? What about ipsilateral level 2? Does the staging modality influence your decision (PET+EBUS vs mediastinoscopy)?
Answer from: Radiation Oncologist at Academic Institution
You bring up a good point. Sometimes there are 'at risk' nodes in locally-advanced NSCLC (LA-NSCLC) that may not be FDG-avid and sit between two or more masses that are FDG-avid or perhaps are enlarged but not FDG-avid. Judgement does come into play when contouring targets. For background, RTOG 05...
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Answer from: Radiation Oncologist at Academic Institution
In my practice I tend to not treat nodes electively for Stage II-III disease, with the understanding that higher risk, occult nodal stations are likely included within the PTV (with several studies demonstrating this). I agree with @Jeffrey D. Bradley about including enlarged nodes, in the vici...