How would you approach treatment for a patient with locally advanced NSCLC and systemic scleroderma if chemoradiation is their only curative option?  

My advice would be to provide some consent that there may be some increased risk of toxicity, especially esophageal, and then treat them as you would if they didn't have scleroderma. I think the literature suggesting scleroderma is contraindicated in radiotherapy is pretty soft. There's been some ...