Background: Oligometastatic disease presents a unique opportunity for local therapy to provide cure. The aims of this study were to evaluate the safety and efficacy of stereotactic ablative radiotherapy (SABR) as a local treatment for isolated lymph node recurrence in a previously irradiated field. Methods: Between January of 2010 and September of 2014, 33 patients were reviewed from a prospectively collected database. Eighteen of 33 patients had biopsy proven recurrence and all patients were shown to have isolated metastases by positron emission tomography (PET)–CT. All patients had previously received full dose radiation treatment with radical intent, with a median total dose of 56 Gy (range, 46-74) delivered with standard fractionation. The median duration from initial radiotherapy to lymph node recurrence was 11.2 months. The overall survival (OS), local control (LC) rate, and disease progression–free survival (DPFS) rate were calculated according to the Kaplan-Meier method. Comparison between prognosis groups and toxicities was performed using log-rank analysis. Results: All patients completed the prescribed treatment. The median tumor dose and fractions administered was 40 Gy (range, 24-50) in 5 fractions. The median follow-up was 10 months (range, 1-33). Three grade 3 toxicities were observed including radiation pneumonitis, displaced fracture, and pelvic pain. No Grade 4 toxicities were recorded. Results at last follow up demonstrated a local control of 90.9%, Regional control (adjacent nodal station) of 66.7%, and distant failure of 27.3%. The median time to any failure was 4.5 months with a 1 year OS of 45.5%, and DPFS 62.3%. Conclusions: SABR salvage to macroscopic nodal recurrences provides local control and long-term disease-free survival in carefully selected patients with a low incidence of toxicities. Further investigation is warranted to identify those patients who benefit most from this treatment modality.