What would be your approach to the treatment of limited stage extrapulmonary small cell carcinoma of the nasopharynx with bilateral cervical lymphadenopathy?

Rare entity and not a whole lot of evidence to base treatment decisions on.

That being said, at least make sure a brain MRI has been completed (I know this seems obvious, but just in case).

If the patient was in good shape, I would treat with concurrent CRT based on a series out of Japan. Whether to use cisplatin alone or cis/VP16 - we just don't know. This will be a toxic treatment in any case and unclear to me how the head and neck will respond to a platinum doublet. But, in this study they did use cis/VP-16, so if the patient was up for it, that's what I would propose. They should get a total of 4 cycles and can start the RT during the 1st or 2nd cycle.

As far as treatment volumes, we really have stopped doing elective nodal treatment for...

Agree with Dr. @Dr. First Last, esp regarding no need for PCI. Extrapulmonary tumors, including small cell, do not drain to the brain unless there are lung metastases.