How would you treat pelvic node recurrence after prior RP and adjuvant XRT prostate bed only?

RT to pelvic nodes to aortic bifurcation, boost positive nodes, plus ADT.

When we first started treating pelvic nodal recurrence, we used to treat involved-field with SBRT at a dose of 35 Gy in 5 fractions. We rapidly realized that some patients relapse elsewhere in the pelvis. We then started to add elective nodal irradiation with integrated boost to the involved nodes. ...

I try to get the previous DICOMs to create a sum plan, with fusion of previous plan based on bony anatomy. If DICOMs are unavailable, an attempt to reconstruct the previous fossa salvage plan should be made.

I don't have a hard threshold of requiring a certain gap, but I do evaluate the sum plan and ...

Nodal recurrences after definitive local therapy can be complicated, and I think the devil is in the details. There is clearly a range of acceptable treatments. If you have a solitary node recurring 10 years after RP and salvage XRT with a PSA doubling time of 5+ years in a 75+ y/o, then SBRT to jus...

At Karmanos, we will frequently use proton therapy when re-irradiating the pelvis for nodal relapses, to minimize the exit dose to the midline structures of bladder, bowel, sigmoid and rectum, and reduce overlap with prior prostate/prostate bed doses. A common salvage dose is 35-40 Gy in 5 fractions...

Some great answers in this thread.

We also offer 25 fractions (45 Gy elective; 55-60 Gy SIB involved) or 5 fractions (25 Gy elective; 30-40 Gy involved) salvage RT routinely.

The question of volumes is a good one since there's growing data that just SBRT to a single node (if no prior elective RT in ...

I have used the GETUG P07/OLIGOPELVIS (Vaugier et al., PMID 38490854) regimen which consists of a salvage pelvic nodal treatment (54 Gy/30 #) with 6 mo of ADT and an involved field RT (IFRT) boost to the PET-identified involved lymph nodes (66 Gy/30 #), which is nicely summarized above and discussed...