Would you recommend surgery +/- adjuvant XRT or definitive XRT in elderly patients with recurrent squamous cell carcinoma of the ear with direct invasion through the cartilage of the helix?

It depends on co-morbidities and functional outcome of surgery. Preferably surgery and postoperative radiotherapy. However, if surgery is not in the cards, radiation alone to 70 Gy in 35 fractions or the equivalent using altered fractionation.