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...

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...

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.

Surgery— to define the disease extent, to provide a chance for cure, to reserve reirradiation.

I think it depends on the bulk of the lymph node. If small, then agree with most here on neck dissection and selective post-op RT. This allows for staging and treatment, and if single-node recurrence, you could observe, but any other higher-risk features you can offer PORT.

I agree with @Dr. First L...