If only SNLN bx is done, then based on GROINNS data, there is a 5% risk of additional node. Since nodal recurrences have a low salvage rate, I would treat with adjuvant RT.

ITCs pose a challenge in many sites, not just in vulvar disease, and I believe we don't have enough data to conclude what should be the standard treatment. In most scenarios, I would often default to the primary disease factors and assess what would the risk of nodal metastasis and decide to treat ...