Chemoradiation is often pursued when surgery is off the table following neoadjuvant chemoimmunotherapy for locally-advanced non-small cell lung cancer (NSCLC). This case report describes a patient with stage cT2aN2M0 NSCLC (PD-L1 60%) initially treated with neoadjuvant carboplatin/paclitaxel plus pembrolizumab with intent for resection. Immune-related dermatitis and colitis derailed the plan, and despite a partial metabolic response, thoracic surgery ultimately declined resection as is seen in roughly 1 in 5 patients receiving neoadjuvant chemoimmunotherapy on trial. He proceeded to standard definitive conventionally-fractionated chemoradiation meeting constraints. Despite modest acute toxicity, several weeks after treatment completion the patient suffered a grade 5 bronchial-esophageal fistula in addition to multiple other significant toxicities. While this obviously raises concern, we have to realize it’s a single case report. Even though there is limited data on radiation following neoadjuvant chemoimmunotherapy, those patients should still have the chance for curative local therapy. | Heintzelman, Pract Radiat Oncol 2025
