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Thoughts?
Neoadjuvant durvalumab plus radiation versus durvalumab alone in stages I–III non-small cell lung cancer: survival outcomes and molecular correlates of a randomized phase II trial - Nature Communications The authors previously reported the primary outcomes of a randomized phase II trial comparing neoadjuvant durvalumab (anti-PD-L1) alone or in combination with stereotactic radiotherapy in patients with early-stage NSCLC. Here, the authors report the secondary outcomes of the trial and post hoc... www.nature.com (Source: Student Doctor Network)
Source: Student Doctor Network - December 29, 2023 Category: Universities & Medical Training Authors: Lamount Tags: Radiation Oncology Source Type: forums

Early stage NSCLC SBRT/hypofrac
Wanted to review how you guys would approach this Got an elderly guy, GOLD 4 COPD, FVC 1.8L, 45% predicted, FEV1 860cc, 28% predicted, FEV1/FVC ratio 47%, with a peripheral early stage NSCLC, about 1.5cm, close to the chest wall, biopsy proven, PET negative, MRI brain negative. No matter what we did, tumor movement was 2cm+ on 4D, even after re-sim, plate/belt, education, etc. I've heard off hand that if movement >1cm you should not do SBRT, others say it is OK if it is a small target... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - August 12, 2023 Category: Universities & Medical Training Authors: Radonky Tags: Radiation Oncology Source Type: forums

Never knew the med onc hatred for us was this bad
Can’t recall the specifics but had a case a colleague told me about a couple of months prior, NSCLC T3ish no nodal disease but positive margins on the resection. We never got the referral for any adjuvant treatment (no further resection was planned). Don’t know the case so I assumed maybe his molecular profile Was very favorable or I didn’t have all the facts. Fast forward a couple of months, whatever therapy he has been on clearly isn’t working and now has a spinal lesion the colleague... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - March 14, 2023 Category: Universities & Medical Training Authors: RTOGsaveRadonc Tags: Radiation Oncology Source Type: forums

Lung SBRT sans biopsy
Probably discussed before, but there are certain instances where imaging findings and history are such that various nodule nomograms would say >95% chance a particular nodule is NSCLC. I'm wondering how often people are treating with no meat, whether there's a greater risk to biopsy than SBRT, or simply patient refusal, and how you're coding this, as in, as a clinical dx of lung cancer or as a pulm nodule. I'm also not infrequently seeing patients who had a pneumo after a nondiagnostic biopsy. (Source: Student Doctor Network)
Source: Student Doctor Network - February 22, 2023 Category: Universities & Medical Training Authors: Ray D. Ayshun Tags: Radiation Oncology Source Type: forums

Preoperative (chemo)immunotherapy for stage III NSCLC
What is the current level of evidence on the subject? Thanks (Source: Student Doctor Network)
Source: Student Doctor Network - October 30, 2021 Category: Universities & Medical Training Authors: seper Tags: Radiation Oncology Source Type: forums

Challenging NSCLC-case!
Here is a challenging NSCLC case. 75 year old patient, good PS. Small primary in the left lung, mediastinum looks mostly clear on PET, only a few very small nodes. MRI of the brain shows solitary <1cm lesion. Histology come backs as adenocarcinoma in the lung, EGFR-mutated. I just SRSed the brain lesion (EGFR-mutation was not known prior to the planning CT ). The thoracic surgeons performed a mediastinoscopy this week to rule out any mediastinal involvement, they resected two nodes... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - October 15, 2021 Category: Universities & Medical Training Authors: Palex80 Tags: Radiation Oncology Source Type: forums

VATS vs SABR for Stage I operable NSCLC
Just saw this in Lancet Oncology: Link Caveats are that it is a single, arm prospective trial and the comparison to surgical arm was based on case-matching, not randomization. But still both arms show overall survival of 91% at three years. Finally a bit of good news in RO. (Source: Student Doctor Network)
Source: Student Doctor Network - October 7, 2021 Category: Universities & Medical Training Authors: Gfunk6 Tags: Radiation Oncology Source Type: forums

Esmo 2021
Interesting talks in the upcoming ESMO 2021 Congress - 17.09-21.09.21 1170O - An international randomized trial, comparing post-operative conformal radiotherapy (PORT) to no PORT, in patients with completely resected non-small cell lung cancer (NSCLC) and mediastinal N2 involvement: Characterisation of PORT efficacy in lung ART (IFCT-0503, UK NCRI, SAKK) Cécile Le Pechoux (Villejuif, CEDEX, France) 1171MO - PACIFIC-R real-world study: Treatment duration and interim analysis of... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - September 15, 2021 Category: Universities & Medical Training Authors: Palex80 Tags: Radiation Oncology Source Type: forums

Incidental renal cell in Stage III NSCLC
Have a patient with Stage III NSCLC with a PET avid (2 cm posterior) mass in the kidney, pending biopsy. Plan for typical chemorads for lung cancer, but wondering if I should SBRT this if it's RCC, and when. Given the typical issues with med onc getting everything perfect before seeing the patient, I figured I could just take care of this thing during the week before the lung/start of chemo. Otherwise, could wait until CRT is done and reassess/go down the typical RCC referral pathway and... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - May 19, 2021 Category: Universities & Medical Training Authors: Ray D. Ayshun Tags: Radiation Oncology Source Type: forums

What after neoadjuvant CT-RT for Lung Ca that remained inoperable?
Dear Colleagues, I hope you are safe. I need your advice concerning my patient 65 years old, who initially presented (at another institution) for a left lung para-hilar mass, 5cm, involving the left lingular bronchi, N2 on Pet, M0. Biopsy: Poorly differentiated NSCLC, EGFR neg, ALK neg, PD-L1 90% He received neo-adjuvant CT (CDDP-Navelbine) + RT 45Gy/25fr. He had a partial response but still inoperable. Last RT session was on october 26/10/20. What to do ? Do you recommend SBRT to the... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - January 28, 2021 Category: Universities & Medical Training Authors: Kroll2013 Tags: Radiation Oncology Source Type: forums

Role of CTV expansion in H & N and Lung primary
Anyone routinely skipping CTV expansions off the GTV (that are taken to the gross disease dose) in the following situations: 1) H&N definitive RT/ChemoRT, omitting a 70Gy 'CTV' expansion of 3-5mm for the primary, in say a Oropharynx patient 2) Same as #1, but for a positive lymph node 3) Definitive chemoRT for lung cancer (NSCLC, LS-SCLC), in regards to the primary 4) Same as #3, but for positive lymph nodes (Source: Student Doctor Network)
Source: Student Doctor Network - January 4, 2021 Category: Universities & Medical Training Authors: evilbooyaa Tags: Radiation Oncology Source Type: forums

What are your PFT thresholds before definitive radiation for NSCLC?
Dear colleagues, I am interested to know your experience/institutional guidelines on how to set PFT (FEV1, FEV1/FVC, TLC, DLCO) thresholds below which you refuse radical radiation to an 80 years old, fit patient, clinically not dyspneic nor depending on oxygen who presents with left lower lobe T3N0 NSCLC invading ribs and chest wall (<5cm)... What are your PFT thresholds before definitive radiation for NSCLC? (Source: Student Doctor Network)
Source: Student Doctor Network - August 16, 2020 Category: Universities & Medical Training Authors: Kroll2013 Tags: Radiation Oncology Source Type: forums

Best dose fractionation to try to induce Abscopal in NSCLC?
Hello dear friends, I have a 60 yo patient, very fit that was diagnosed of a left NSCLC, that was resected and received adjuvant RT for N2 disease. She did very well. 2 years later she developed 4 small nodules in the right Lung (controlateral) as only site for disease progression. Biopsy revealed NCSLC , PDL-1+>90%. She received a Immunotherapy. at the follow-up, the number of lesions increased to 7 nodules. 2 out of 7 increased in size - with one adherent to the chestwall and that may... Best dose fractionation to try to induce Abscopal in NSCLC? (Source: Student Doctor Network)
Source: Student Doctor Network - March 7, 2020 Category: Universities & Medical Training Authors: Kroll2013 Tags: Radiation Oncology Source Type: forums

NSCLC - solitary brain met; ?management of thoracic burden?
Looking for further input, as I've struggled with these cases in the past.... I've had different variations on this, but looking for what people do in these cases. Let's say you have a fit patient with T4 (small mediastinal invasion)N0M1 squamous cell of lung with a brain met. Asymptomatic from chest disease. Symptomatic from met. Met is being managed with surgery followed by radiosurgery (or in a very small met managed with SRS)... How do you manage the chest? Chemo (full dose) -->... NSCLC - solitary brain met; ?management of thoracic burden? (Source: Student Doctor Network)
Source: Student Doctor Network - December 20, 2019 Category: Universities & Medical Training Authors: BobbyHeenan Tags: Radiation Oncology Source Type: forums

Clinical case management - IIIA NSCLC
This is something that I've realized is extremely regional and doesn't seem to follow anything except what the group has decided they'd like to do. At residency we treated one way, first job treated another way, and now another way. Example case: 64 year old man with 35 pack year history presents with cough and slight worsening of SOB. CXR shows right hilar mass, CT shows 3.5cm suprahilar mass and enlarged (1.8cm) right paratracheal LN. EBUS/bx performed for dx and both the suprahilar mass... Clinical case management - IIIA NSCLC (Source: Student Doctor Network)
Source: Student Doctor Network - November 9, 2019 Category: Universities & Medical Training Authors: ROFallingDown Tags: Radiation Oncology Source Type: forums