What is your approach to adjuvant RT or chemoRT in LS-SCLC s/p lobectomy with N1 disease?

I am unaware of any data suggesting a benefit of adjuvant RT in this scenario assuming completely resected. In the absence of data, I would not recommend adjuvant RT in an N1 patient, rationale below. Adjuvant systemic therapy would be strongly recommended.

My thought process to this is that SCLC has a higher propensity for systemic failure than NSCLC. To the point that chemotherapy is the *most* important therapy in definitive management of LS-SCLC. RT helps, yes, but is a second fiddle.

In the setting of N1 NSCLC that is post-op, we have the old subset analysis of the ANITA trial that told us post-op RT was unnecessary in patients with post-op N1 NSCLC who got adjuvant chemo, and that's for a diagnosis that is less likely to benefit from ...

This was thought to be an early-stage disease (T1-T2N0M0) and the decision was made to undergo lobectomy + hilar/mediastinal LN assessment. This is certainly an option based on NCCN guidelines. After surgery, there was an occult N1 node seen on the path. These patients are still at very high risk of systemic recurrence so they absolutely need systemic therapy.

As for the role of RT, it is not well defined. NCCN gives it the old +/- concurrent or sequential RT recommendation based on expert opinion.

If the patient has a good performance status, I will discuss the pros (potentially better local control/survival) and cons (toxicity from treatment, unknown whether RT changes survival). It is reasonable to omit, but I would likely treat concur...