How would you approach a stage III NSCLC that is a biopsy-proven new primary located in the same field as a prior stage III NSCLC previously treated with chemoRT?

First, I'd need to know the interval since the previous course of radiation. If it was recent, this may simply be the growth of a resistant subclone. Next Gen sequence comparison can be helpful here.

If the interval was >3 y, it may well be a new cancer. I would give the patient the benefit of the d...

If >1 year since conventional fractionation, presumably to 60-70 Gy, I would feel comfortable repeating full dose chemoradiation with IMRT/IGRT and I would not compromise tumor coverage in an attempt to satisfy plan sum based constraints which would most likely result in a palliative treatment only....