It probably depended on a couple things. It’s obvious that in this time frame this is incomplete primary treatment, not a recurrence. In most cases doing surgery and then radiation on this is just duplicate treatment. Knowing that the radiation would deal with this small area, it’s not like they needed to debulk it before radiation, so outside of financial gain why would they do surgery again?

Surgery serves different purposes. 1. Complete primary treatment in very small focal cancers. 2. After having the maximum radiation exposure, salvage surgery to get what was not eradicated in the primary treatments with radiation. This is where things become often permanently damaging in terms of loss of structure, and compromised functional and esthetic outcomes. 3. Elimination of disease that is too close in proximity to vital structures that radiation would cause irreparable harm to. 4. Occasionally exploration of areas that cannot be visualized in scans adequately to determine the proper course of action. 5. And of course biopsy to confirm what you are actually dealing with, the gold standard.

None of these in your continued case is served.