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...