How would you proceed for a patient with metastatic gastric-type adenocarcinoma, with vaginal and inguinofemoral disease only, who experiences complete response to her vaginal tumor but residual inguinal disease?  

There is no ideal data to guide this. I would recommend surgical nodal excision of the residual inguinal disease, followed by pelvic and inguinal radiation (with or without platinum if the patient can tolerate further). Another approach would be with cisplatin-based chemoradiotherapy with treatment ...

I have treated these so called isolated vaginal recurrence which is usually supravaginal disease from peritoneal deposit with vaginal extension with definitive RT with EBRT with higher dose to nodes plus brachy (have added concurrent xeloda). I have few patients with long term DFS.