Hi Rahul,

I am no doctor and have not a long history here but my view is the first surgery did not get it all and the surgeon did not have clean margins to ensure he got it all. The rads should have killed what remained but it appears not and this is the place of the recurrence so this makes sense.

Chemo, from my understanding kills only small cell cancers. If the recurrence is large enough, what this size is I do not know, but at some size of mass, chemo does not kill the cancer, it may shrink it but not kill it. So only doing chemo now seems inadequate for the given state of the cancer. Waiting to do surgery seems like losing time rather than doing it now or going back and hitting it with rads.

But as you mention he already had IMRT, so there are limits to the amount of grays one can be given to the same place.

Good luck,
Don