How would you approach a patient with biopsy-proven extrapulmonary small cell carcinoma (CT chest negative), characterized only by inguinal lymphadenopathy, who is otherwise asymptomatic?   

Concurrent chemoradiation with etoposide and cisplatin and radiation to large inguinal field. Patient should have brain MR before and after therapy. It is not known whether PCI should be offered at conclusion. I would not push hard for that.