Would you offer definitive chemoRT for NSCLC with histologically-proven contralateral station 11 nodal involvement?

Contralateral hilar involvement is staged as N3 per AJCC 8th edition. In that regard, the management of an N3 patient should mimic that which we consider for any locally advanced IIIB or IIIC patient. Full staging including brain MRI is necessary. Pulmonary function testing including spirometry and diffusion capacity will identify potential risk factors for lung injury. If the patient is considered fit for treatment then the standard of care is concurrent chemoradiotherapy followed by consolidat...

Most importantly, get a biopsy to confirm the contralateral LN is real. If positive, these patients need both drugs and radiotherapy to have an optimal chance at long-term survival. Local control remains a problem which is why concurrent is favored over sequential. If safe, CRT can be optimized by dropping the CTV altogether (0 mm); just make sure the PTV is sufficient to hit the target given off-axis rotational issues. If unsafe, start with the best drug combination (chemo-ICI) and come back wi...

Yes. Can cover PTV 95% at 95%, motion management (eg: phase gating), precise contours/expansions (crop CTV out of anatomy that is not at risk), and image guidance to minimize PTV expansion. Adaptive treatment (shrinking target volume as tumor responds) is not standard yet but is used occasionally at some places including my institution. Protons are a backup if there’s no feasible way to treat with photons (should be unusual).