How would you mange a completely excised true anal margin squamous cell carcinoma, with anal canal uninvolved, with positive inguinal nodes that were not managed surgically?

What fields/lymph node regions would you treat? What doses would you use both for the postop primary and the nodal regions?

Answer from: Radiation Oncologist at Academic Institution

Chemo RT to anal margin, anal canal, inguinal and pelvic nodes to 45 Gy/25 fx. Boost positive inguinal nodes to 55.8-59.4 at 1.8 Gy/fx. PET at 3 months. Resect whatever is left (hopefully nothing).

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How would you mange a completely excised true anal margin squamous cell carcinoma, with anal canal uninvolved, with positive inguinal nodes that were not managed surgically?

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