How would you manage a local recurrence at the skull base after concurrent chemoRT for locally advanced nasopharyngeal carcinoma?

Available data does not support re-irradiation when the recurrence is less than 1 year after primary treatment.

In this case I would favor systemic therapy, either with platinum-gemcitabine or Pembrolizumab if pts tumor is PD-L1 positive.

I agree with Cesar. I would also get molecular profiling (Foundation One or similar) because there may be trials available in the future.