Can you omit the vulva from the radiation field in isolated LN recurrence several years after initial vulvectomy/nodal dissection without adjuvant RT?

In my opinion, yes, assuming the patient has had a recent well-done pelvic examination with close inspection of the vulva and vagina. A more difficult question, I think, is whether to treat the ipsilateral pelvic LN's. In general I would favor treating ipsilateral pelvic LN's to microscopic disease ...

Salvage rate for nodal relapse is low. I would favor concurrent chemo RT targeting at least groin and pelvis and may consider contralateral groin based on initial location of disease and extent of dissection