What is your approach for locoregional mediastinal recurrence of NSCLC adenocarcinoma in fit patients >5 years from definitive treatment (chemoradiation and/or surgery)?

There are a lot of variables here including number of lymph node stations involved, bulky vs non bulky disease, and lung/cardiac function. I would treat this similar to de novo diagnosis given the timeframe from prior treatment as this is unlikely to be an isolated relapse this far out. Definitive chemoXRT to durva or induction/surgery are reasonable

I would consider this a late relapse if same histology. Given the prior radiation therapy, I would think toxicity would be great from radiation.

I would treat this as recurrent disease, and depending on histology and PDL1 status use immunotherapy +/- chemotherapy unless adenocarcinoma PDL- in which case chemotherapy. If you are really convinced that there really is a new primary clinically and not just predominately mediastinal disease with recurrence at the original primary, then I would genotype the patient in case targeted therapy is an option. I doubt if the patient received radiation this would be tolerable at the recommended doses and use targeted therapy if an option, or again chemo-immunotherapy. This is really 2 questions as if the...