How do you approach RT coverage of an abdominopelvic lymph node in the oligometastatic or oligorecurrent setting?

Speaking specifically about prostate cancer, after treating a number of these with SBRT and having them fail in an adjacent node, me and everyone in our group will tend to treat the entire nodal chain with an SIB to the grossly involved LNs. The only exceptions are in those patients where prior RT p...

Usually, treat chain or region with SIB to GTV for prostate and most gyn cancer except probably ovarian cancer or unless there are contraindications or it is reradiation.

Ling et al., PMID 31150869

While I find the responses interesting and the different approaches valid, I don’t think they really answer the question. Obviously, there are a number of variables that would influence the approach (including but not limited to age, performance, PSA trends, initial staging, etc.). I’ve treated both...

Most data indicate a high rate of failure with node alone RT. We will see if PSMA scans change this. I treat the nodal region with a boost. I don't follow Dr. @Dr. First Last or his anecdote.

Regardless of the cancer type, I only treat visible tumors. That's because there are boundless invisible tumors throughout the body, and the increased risk of treating a few more nodes - just to be safe - seems to defy common sense for a patient with stage IV disease.