Testo Vitality recommended to proceed with new adjuvant chemotherapy followed by either followed by inguinal lymph had subsequent surgical resection now three patients had no tumor under the surgical specimen and 9 patient had no evidence of disease at a median follow-up about 34 months and 11 of the 22 patients who went on to have surgical resection went on to have tumor progression now overall it should be noted that the chemotherapy improved progression-free survival as well as overall survival and it was noted that with chemotherapy there was significantly higher incidence or incidence of absence of my lateral residual tumor and absence of extra nodal extension and when it comes to a radiotherapy with a bulky tumors robbie and colleagues in 1994 again this is these are a little bit older studies all of these but they seem to really influence the infirmity the modes of treatment out there right now and they demonstrate that benefit of radiation as a new age of an adjuvant and palliative method in 122 patients or hunts are 120 patients and they found that in cases where you know patients were non resectable disease they were able to proceed with surgical research achill resection and palliation was offered in c