How would you treat a seminoma recurrence to para-aortic LN one year after a transscrotal surgery?

Theoretically one may need to change the volume to include the inguinal and bilateral pelvic nodes but am not aware of any outcome data which supports that.

I would favor ipsilateral pelvis and paraaortic region with boost to node and not include scrotum and avoid exposure of contralateral testis to...

I do 2500 to the ipsilateral pelvis and paraaortic nodes with a 1000 boost to the node. Wish I had data to back up that answer but that has been my answer. Less toxic than chemo if I stop at T 11-12 rather than threaten the heart toxicity