When would you include uninvolved nodal stations when treating patients with locally advanced NSCLC with definitive CRT?

You bring up a good point. Sometimes there are 'at risk' nodes in locally-advanced NSCLC (LA-NSCLC) that may not be FDG-avid and sit between two or more masses that are FDG-avid or perhaps are enlarged but not FDG-avid. Judgement does come into play when contouring targets. For background, RTOG 0515 (IJROBP 2012; 82(1):435-41) was a phase II comparison of GTV definition with or without the use of PET fusion to contour LA-NSCLC targets. In that prospective dataset, 1/47 patients (2%) developed a ...

In my practice I tend to not treat nodes electively for Stage II-III disease, with the understanding that higher risk, occult nodal stations are likely included within the PTV (with several studies demonstrating this). I agree with @Dr. First Last about including enlarged nodes, in the vicinity of GTV, that are not PET avid.

Nevertheless, in the back of my mind is a 2009 editorial that advocates for consideration of elective nodal radiation. While it is an 8 year old editorial, I suggest reading ...