How would you treat a previously irradiated localized recurrence of an adenoid cystic carcinoma of the nasopharynx?

Assess resectability. If not suitable for gross total resection, and likely not, protons.

I have used 66 Gy/55 fx at 1.2 Gy/fx given BID to gross disease along with 55 Gy/55 fx to at-risk cranial nerves. Disease was locally recurrent along nerves in a field that had previously gotten 66 Gy/33 fx ~15 years ago. The patient was symptomatic with facial weakness and pain. She was extensively...