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Radiation Oncology • Thoracic Malignancies
Would you offer postoperative radiation for a patient who initially had biopsy-proven multistation N2 NSCLC but had a nodal pCR upon surgical resection+ LND after neoadjuvant chemo-immunotherapy?
Would it change if only one of the initially sampled positive stations was removed at surgery (eg both 4 and 7 positive pre-therapy, but only 7 sampled and negative at surgery)?
Answer from: Radiation Oncologist at Academic Institution
I would not routinely offer PORT for completely resected N2 disease based on lack of survival benefit from LungART (have my qualms about ~90% 3DCRT and the probable impact on cardiothoracic toxicity), particularly in a patient who appears to have had a fantastic response to neoadjuvant therapy. I th...
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Answer from: Radiation Oncologist at Academic Institution
I agree with the excellent comment made by Dr. @Ryan Whitaker. In light of LungART and the PORT-C study which did incorporate IMRT, both of which did not show a survival benefit for PORT, I do believe we need to tailor PORT based on certain risk factors. A patient with a pCR in my opinion, would not...