How would you approach a locally advanced NSCLC s/p pneumonectomy now with multi-station mediastinal nodal recurrence?

Very tough clinical scenario. I routinely say that in an era where we have good options with both peri-op chemoimmunotherapy or chemoradiation followed by immunotherapy, patients with LA-NSCLC shouldn't be getting pneumonectomies (with rare exceptions). Stepping off that soapbox, I'd start with a goal of 60-66 Gy conventionally fractionated and would contour this like any locally advanced nodal case (GTV + CTV to encompass nodal space at involved levels + ITV for motion of that space + 5 mm PTV ...

The question is fairly broad since we don't have the imaging details, nor do we have details regarding the prior treatment besides surgery. And we don't have any details about PD status, EGFR/alk, response to prior systemic therapy, etc. So, assuming no prior RT and just chemo/IO then surgery, or surgery alone, we will press forward.

I would treat it similarly to any unresectable stage 3 lung cancer (they had a large and morbid biopsy at this point). Ideally, chemoRT with consideration of outbac...