How would you treat bilateral groin recurrence of vulvar small cell neuroendocrine carcinoma in a patient who has previously had pelvic and groin radiation?

I would start with chemo-immunotherapy, like in pulmonary small cell, as this is likely to be the tip of the iceberg. If no prior groin surgical exploration, this can be considered by gyn/onc. If not, I would consider focal reirradiation of any residual disease after chemotherapy during IO maintenan...