How do you treat elective neck regions in a patient with a second primary HN cancer and prior neck dissection and radiation?  

Almost all re-irradiation trials and retrospective series have targeted the gross disease alone, without electively treating nodal basins. Even with this limited target volume, grade 4 toxicity is 20-30%, and treatment related deaths occur in 5-10% of patients. Locoregional control is only about 50%...