When Toxicity Exceeds Benefit: A Case of Thoracic Reirradiation

Discussions regarding the intent of local therapy in the setting of metastatic disease are nuanced and require the input of the patient in shared decision-making.1 In my practice, patients have shown a variable threshold for risk in ultracentral, isolated, inoperable metastatic disease. I use a hypofractionated approach for upfront management of patients like this, especially in radioresistant histology. Excellent performance status is a dual indication for both definitive local therapy and maintenance systemic therapy.