Would you recommend repeat radiation therapy for a painful perineal recurrence in a patient who failed definitive CRT, and recurred again after salvage abdominoperineal resection (APR)?  

I think repeat radiation therapy is certainly an option that can be offered to this patient, especially if the interval between treatments is long. MD Anderson reported on a series of 10 patients with anal SCCs treated with reirradiation after definitive CRT (https://www.ncbi.nlm.nih.gov/pubmed/277...

I would add that if the recurrence is not exceedingly thick then concurrent hyperthermia with re-irradiation is a feasible option, especially in a patient who cannot tolerate concurrent chemotherapy. I have personally used External thermal therapy (ETT) is this setting and patients have had excellen...