In clinically node positive vulvar cancer, are you recommending bilateral inguinal LND or nodal debulking followed by adjuvant radiotherapy?

I am sure there is wide variation in practice as there is no prospective study to guide care.

Our approach is definitive chemo RT with the removal of only residual persistent node.

Richman et al., PMID 32981696

We also do not routinely perform nodal surgery prior to chemoradiation. We know that the patients are going to need at least radiation +/- chemo even after surgery. We dose the nodes as we would gross disease, either 64-66 Gy in 2 Gy/Fx or consideration of SIB regimens such as 60-62.5 Gy in 25 fract...

Generally, definitive chemoradiation with adequate radiation boost dose to the gross node is effective.