Adjuvant radiation alone for focal positive margin gastric cancer

[Treat]

Hi all, as usual, I would like to get some opinions on a case.

75 year old with T4N1 (2/32) gastric cancer resected with a focally positive distal margin.

No chemo as the patient is concerned about toxicity.

Would you:
Treat to 45Gy as there aren't any other options?
Or not treat, as there isn't much evidence, and 45Gy may not be enough for microscopic disease?
Treat higher than 45 Gy??

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[Palex80]

Treat. Boost after 45 gy to 50.4 or 54 gy (if you are adventurous) for focal margin.

 

[seper]

I boost also, based on duodenum and other small bowel DVH.

 

[medgator]

I'd go 45/54 boost to + margin with imrt and hard sell xeloda.