How would you treat pelvic node recurrence after prior RP and adjuvant XRT prostate bed only?  

When we first started treating pelvic nodal recurrence, we used to treat involved-field with SBRT at a dose of 35 Gy in 5 fractions. We rapidly realized that some patients relapse elsewhere in the pelvis. We then started to add elective nodal irradiation with integrated boost to the involved nodes. ...

RT to pelvic nodes to aortic bifurcation, boost positive nodes, plus ADT.

At Karmanos, we will frequently use proton therapy when re-irradiating the pelvis for nodal relapses, to minimize the exit dose to the midline structures of bladder, bowel, sigmoid and rectum, and reduce overlap with prior prostate/prostate bed doses. A common salvage dose is 35-40 Gy in 5 fractions...

I try to get the previous DICOMs to create a sum plan, with fusion of previous plan based on bony anatomy. If DICOMs are unavailable, an attempt to reconstruct the previous fossa salvage plan should be made.I don't have a hard threshold of requiring a certain gap, but I do evaluate the sum plan and ...