Do you preform elective nodal irradiation in patients with locally advanced NSCLC who are not candidates for or refuse chemotherapy?

No. Usually if they are not candidates for chemotherapy, there are reasons for it, such as medical comorbidities, that would make you want to limit your radiation fields as well. I would consider treating to a higher dose such as 66 Gy, without systemic therapy.

Would not do ENI.

Data presented at ASTRO supports hypofractionation for these patients instead of 60-70 Gy in conventional fractionation without chemo

When thinking through this, one can also consider how Bernie Fisher thought through the issue of "less treatment" (lumpectomy) for cancer and how Blake Cady thought about the futility of treating lymph nodes (spedometers whose removal do not disengage the engine). If the disease is already even regionally metastatic, then ENI may likely be too little too late. If it is more indolent, then ENI is potentailly too much too early which as Ken points out, could be particularly morbid in a pt too frail for chemotherapy.

If you have not heard of Blake Cady, an infamous surgical oncologist who most of Eli Glatstein's proteges are familiar with, you must make the time to read his Presidential Address to the SSO in 1997 with particular attention to t...

There are mulitple publications from high volume centers showing that omission of ENI did not negatively impact outcomes.