How would you treat a patient who has progression of nodal metastases while receiving neoadjuvant gemcitabine/cisplatin?  

This tumor biology appears resistant to cisplatin, therefore would consider alternative systemic therapy, e.g. clinical trial or immune checkpoint inhibitor or erdafitinib (if FGFR2 or FGFR3 activating mutation or fusion). The role of locoregional therapy depends mainly on the response on the system...