How would your elective nodal coverage change in a patient with anal cancer metastatic to a high external iliac node?  

I agree with the comments above, but I have an additional comment. For some reason as a field, we have pushed the dose to electively treated regions to 45 Gy, although there are no data in the literature to justify that high a dose. I would extend the radiation fields to the celiac axis but would li...

PA nodes should be designated N2, not M1. Elective coverage is an important consideration. It's a judgement call how far up to cover. I agree with @Krishan R. Jethwa's comments and recommendation if it was just one ext iliac node. However, it is not common to have direct spread to an ext iliac node ...

If it was a high external iliac node and small bowel positioning was favorable, I’d extend superiorly to the aortic bifurcation to include the common iliac nodes, i.e. 1 lymph node echelon above.