How would you approach an isolated supraclavicular nodal recurrence involving the skin in a patient who has received standard chest wall and nodal radiation therapy?  

Very challenging situation. Assuming it has been a few years out from the standard RT, and that the nodal mass is in relatively close proximity to the brachial plexus (as it cannot be too far), I would consider: Repeat external beam RT, hyperfractionated to increase the therapeutic ratio (i.e., redu...

I have treated nodal recurrences in the supraclavicular area with SBRT with anecdotally good results for local control. Neoadjuvant systemic therapy can be considered to reduce the bulk of disease. The brachial plexus cumulative dose is the most important constraint to respect, though the BP likely ...

I agree with the above. If this is superficial, involving skin, brachytherapy is an option. Hyperfractionation after chemotherapy is a great option if this is deep. A limited field is what I would choose. Concurrent chemotherapy is also suggested. If this is superficial and you have hyperthermia, an...