With the addition of pembrolizumab following chemoradiation per KEYNOTE-A18, would you be less likely to treat the paraaortic chain prophylactically?

If a patient with a positive node just above the common iliac bifurcation, and will be treated with chemoradiation --> pembrolizumab according to A18, would you still treat the whole paraaortic chain or just extend a few CM margin above the highest node? Are you concerned that paraaortic LN irradiation may blunt the immunotherapy response?

Answer from: Radiation Oncologist at Community Practice

I would favor the same volume of RT with or without pembro. If there is an indication to treat PA nodal chain, would treat as per plan.

Comments

Radiation Oncologist at Comprehensive Hematology Oncology Llc
Agreed, no data to support changing field size in ...

Radiation Oncologist at Allan Blair Cancer Centre
Agree. There is no evidence to deviate from applyi...

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With the addition of pembrolizumab following chemoradiation per KEYNOTE-A18, would you be less likely to treat the paraaortic chain prophylactically?

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