How would you treat an isolated para-aortic node recurrence 1.5 years after receiving primary chemoradiation for locally advanced cervical cancer?

We treat with definitive chemo RT to pa region using IMRT (weekly cisplatinum with 45 in 25 to pa region and 55-57.5 Gy in 25# SIB to node). Small bowel and duodenum dose constraints (V55 < 5 cc and V55 < 1cc respectively).

Agree with Dr. @Dr. First Last, if not previously radiated would definitely consider definitive radiation for this patient in a potentially curative setting. If the area has already received max lifetime dose, could treat with systemic therapy with cisplatin/taxol/bevacizumab) vs evaluate for resection (though this would not be considered standard of care).

Additionally, clinical trial would be a great option, as they would be eligible for multiple.

This is a variation of a scenario posed in the question. I have a patient who I treated for a node positive IB2 (IIIC2 by today’s staging) cervical cancer for which she completed standard treatment with cis+WPRT&PA nodes+HDR Brachytherapy in 2016. Dose was 4500cGy to whole pelvis and PA nodes with Sequential boost to 5580cGy to single gross positive pelvic and single positive PA node. Bowel was kept under 5500cGy max dose. She tolerated treatment well. She was subsequently found to have a left SCV node on follow up PET and was started on palliative chemotherapy which she completed in early 2018. Later that year, she palpated a node in her left SCV, and PET revealed persistent SCV activity (SUV 12) as well as a small focus of disease just po...

Yes, absolutely agree with @Dr. First Last and @Dr. First Last. I have treated these patients with definitive chemoradiation (45/25 + cisplatin), with integrated boost to the gross nodes to 55 or 57.5, OARs permitting.

Close follow up is paramount in these patients afterwards, as the risk of developing further out of field disease is fairly high.