How would you approach a patient with mediastinal-only recurrence of small cell lung cancer < 6 months after primary surgical resection and adjuvant platinum-etoposide for Stage I disease?

The patient still has limited-stage, potentially curable disease assuming the PET/CT and MRI brain do not show any other sites of cancer outside of the mediastinum. Treatment should consist of chemotherapy plus early concurrent thoracic radiotherapy (TRT). This situation is analogous to mediastinal-only recurrence in previously resected NSCLC in which studies have shown that survival outcomes with concurrent chemo/TRT are similar to those achieved in patients with de novo stage III disease.

Radi...