Part of randomisation 1.

The total treatment duration (Inguinal Lymph Node Dissection (ILND)) is estimated to be over 1 day for those patients allocated to Arm A - standard surgery.

Part of randomisation 1.

Patients will receive up to 4 cycles of Paclitaxel, Ifosfamide, and Cisplatin (TIP).

Administration on an outpatient basis:

Paclitaxel 175 mg/m2, day 1, Ifosfamide 900 mg/m2, days 2-5, Cisplatin 15 mg/m2, days 1-5

Administration on an inpatient basis:

Paclitaxel 175 mg/m2, day 1, Ifosfamide 1200 mg/m2, days 1-3, Cisplatin 25 mg/m2, days 1-3

Part of randomisation 1.

Radiotherapy dose is 45Gy in 25 fractions over 5 weeks using 6-10 MV photons to all regions.

Concurrent cisplatin 40mg/m2 will be given weekly, subject to GFR>45mls/min.

Part of randomisation 2.

Prophylactic pelvic lymph node dissection (PLND) - The total treatment duration is estimated to be over 1 day.

Patients who have NOT received neoadjuvant chemoradiotherapy will receive adjuvant chemoradiotherapy:

Cisplatin 40mg/m2 will be given weekly, subject to GFR>45mls/min.

Groin: One or both groins may be boosted up to 54Gy in 25 fractions. An IMRT boost of up to 57 Gy can be given to recurrent or residual macroscopic tumour

Pelvis: the dose is limited to 45Gy unless IMRT is available. An IMRT boost of up to 54Gy in 25 fractions is applied to:

1. Any macroscopic tumour or pathological lymph nodes
2. Electively to external iliac nodes in patient with high disease burden

Patients who have had neoadjuvant chemoradiotherapy will have prophylactic PLND alone.

Surgery to remove the lymph nodes in the groin near to where the cancer first appeared.

The primary outcome measure that will be measured for all trial patients is survival time. This is defined in whole days as the time from the date of randomisation to the date of death from any cause; for those who have not been reported as dead at the time of analysis, the survival time will be censored at the date of last follow-up.

Disease-specific survival time which is defined in whole days as the time from the date of randomisation to the date of death specifically from disease; for those who have not been reported as dead at the time of analysis, the survival time will be censored at the date of last follow-up and for those whose death is reported as non-disease specific then the survival time will be censored at date of death.

In addition to the outcome measures, the acceptability of both randomisations will be monitored based on the proportion of eligible patients approached for randomisation, the proportion of approached patients consenting to randomisation and the proportion of randomised patients receiving their allocated treatment. This will provide ongoing information regarding the feasibility of the trial successfully completing to target.