What is the best management for a local recurrence for a stage I NSCLC treated previously with SBRT?

There is little data to guide management in this scenario given high rates of local control with SBRT and a relatively frail patient population at risk for intercurrent death, reducing the number of patients at risk for local failure.

Given the lack of data, utilization of first principles and a bit of common sense is imperative. First, if a relatively robust patient has radiological evidence of recurrent disease after SBRT, then the first step (assuming the patient is a candidate for further therapy) would be a biopsy and then appropriate staging to confirm the disease is localized. Second, if the tumor recurred despite a good SBRT approach, then I would explore non-RT options first, including surgery, radiofrequency ablation, etc. For sma...