How would you manage a small to medium sized but unresectable nodal recurrence within the original treatment volume for a head and neck squamous cell carcinoma?

There are a lot of points to consider before you can make this decision:

1. what is the time interval from prior RT?
2. what dose was received to this node from prior RT?
3. what are the critical organs at risk if you were to treat this node?
4. why is this node considered unresectable?
5. how large is the nodal ...

There are 3 papers published in 2018 addressing some of these questions. A prognostic index, a comparison of conventional (IMRT) re-irradiation and SBRT, and an assessment of dose, fractionation, and volumes if performing conventional IMRT re-irradiation (Mar 2018, IJROBP).

If electing SBRT, doses in...