How would you manage locoregionally advanced NSCLC with extensive tracheal "mucosal malignant" skip lesions covering almost the entire trachea?

Although I've never encountered this exact situation in practice, I would say that this is very similar to cases that require extensive mediastinal radiation to cover all of their gross nodal disease.

My prescription would remain 60Gy in 30 fractions and I would attempt to meet the standard esophageal constraint of mean dose <34Gy. Additionally, I would also attempt to keep hotspots out of the esophagus. It should be noted that the dose constraint we use for lung is to theoretically prevent grade 3 or higher toxicity. If those constraints cannot be met then they will possibly have significant esophagitis requiring PEG. Furthermore, RTOG 0617 states that the esophageal constraint is not an absolute requirement but is strongly recommended.

As...