When would a completion inguinofemoral node dissection followed by adjuvant RT (+/- chemo) be favored over definitive RT (+/- chemo) for SLN+ vulvar cancer?

The interim analysis of the GROINSS-V II trial showed a recurrence in 12.2% (10/82) of patients treated with radiation in the setting of positive sentinel lymph node biopsy for vulvar cancer. On subset analysis the risk of nodal recurrence was 2.2% for micrometastases (< or = 2 mm) and 20% for macrometastases and they changed protocol and mandated dissection followed by RT for macrometastases. We wrote a commentary on that analysis with comment about contouring guidelines which were sepcified in that study and issues with it which lead to change in the protocol

.https://www.ncbi.nlm.nih.gov/pubmed/25128606https://www.ncbi.nlm.nih.gov/pubmed/25128606

In practice for micrometases, we offer chemo RT after SNLN and consider for dissection for mac...