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Topics:
Radiation Oncology • Thoracic Malignancies
Would you offer definitive chemoRT for NSCLC with histologically-proven contralateral station 11 nodal involvement?
If so, how would you approach managing the increase in lung dose required to cover these? Would you consider this metastatic disease?
Answer from: Radiation Oncologist at Academic Institution
Contralateral hilar involvement is staged as N3 per AJCC 8th edition. In that regard, the management of an N3 patient should mimic that which we consider for any locally advanced IIIB or IIIC patient. Full staging including brain MRI is necessary. Pulmonary function testing including spirometry and ...
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Answer from: Radiation Oncologist at Community Practice
Most importantly, get a biopsy to confirm the contralateral LN is real. If positive, these patients need both drugs and radiotherapy to have an optimal chance at long-term survival. Local control remains a problem which is why concurrent is favored over sequential. If safe, CRT can be optimized by d...
Answer from: Radiation Oncologist at Academic Institution
Yes. Can cover PTV 95% at 95%, motion management (eg: phase gating), precise contours/expansions (crop CTV out of anatomy that is not at risk), and image guidance to minimize PTV expansion. Adaptive treatment (shrinking target volume as tumor responds) is not standard yet but is used occasionally at...