How would you approach a hilar and mediastinal recurrence after conventional chemoradiation for a hilar primary NSCLC?

It would be important to know the time frame that has elapsed since initial chemoradiation, whether the recurrence was entirely in-field or perhaps marginal, and also whether the recurrent disease is limited only to the hilum and mediastinum or if there are other sites (to determine the relative benefit of re-irradiation).

Typically, assuming this was an in-field isolated recurrence, I would wait a minimum of 6 months to consider re-irradiation, with 12 months preferred to allow for normal tissue...