How would you treat an elderly, frail patient with a bulky penile SCC with bilateral inguinal nodes?

These are challenging cases. Conventional wisdom is that patients with bulky nodes are considered rarely curable without surgery: However, this has not been my experience. Nevertheless, to achieve a durable outcome, including cure, our practice has been to use combined chemotherapy and radiation therapy in these patients who refuse or are unable to have surgery. The approach we have taken follows an anal SCC paradigm, and we have published our results on these remarkable outcomes:

McComas et al., PMID 32335061

and have a review/editorial here: Jonathan Tward, PMID 29950592

However, the question stem implies chemo is off the table. I would still strongly advocate for combined chemotherapy with chemo at a reduced dose, as I think that therapy of...