How would you approach a locally recurrent, unresectable (due to COPD) NSCLC that is ROS1 positive?

It depends on extent of disease, pattern of recurrence. Is this a recurrence post resection? Did the patient receive adjuvant chemotherapy previously? Is it limited to mediastinum? If the patient qualifies for chemotherapy and radiation i would consider it. If he/she do not qualify due to extent of disease, would recommend targeted treatment with crizotinib. Not enough details to answer the question definitively. SBRT would have a role if recurrence is limited to a small lung lesion, no lymph no...