How do you manage a nodal recurrence of an early stage glottic laryngeal cancer previously treated with definitive radiotherapy?

As a general rule, patients with post-RT recurrences that are resectable should undergo surgery rather than re-irradiation, unless surgery is expected to be associated with substantial risk or functional deficit (in which case the patient should be consulted about the risks of each modality). In the...

Neck dissection and watch if there is no ECE and/or multiple nodes. If the above treatment involved a field with PORT ± chemo as appropriate. Watch the brachial plexus constraints. The above assumes staging was negative for DM.

I tend to favor just treating the neck where the disease declared itself rather than a more comprehensive approach.

This is my general approach for metachronous nodal recurrences. In the rare historic cases I have seen, particularly with a single node, and usually these are N1 or small N2a, consider...