Surgical pathology found close medial margin but no other adverse features. Would you favor omission, VBT, or EBRT?
Surgical pathology found negative pelvic/inguinal nodes, but revealed also focal LVI/PNI
What volumes would you treat for the primary?
The patient has undergone a vulvectomy years ago. The disease now involves the vulva, perineum, and peri-anal regions.
This is a less common histology in the vulva.
Is there high quality data to support debulking in terms of oncologic outcomes? Does HPV/p53 status impact your decision?
GOG 205 treated vulvar cancer patients to a dose of 57.6 Gy to sites of gross disease, which is somewhat less than what is suggested in cases of defin...
What is considered the optimal interval from time of excision, partial, or radical vulvectomy and/or nodal dissection to initiation of post-op RT?
Bone marrow preservation is important due to poor hematologic function. Chemotherapy is not possible as well.
What factors would push towards treatment? The patient had recurrence of a pT1bN0 vulvar SCC within a year of original surgery. Re-resection shows aga...
Treat as invasive disease with concurrent chemotherapy? Any non-radiation options for large in-situ disease? If RT, would you include at least inguina...
Margins widely negative - 1cm, and full bilateral inguinofemoral lymphadenectomy performed.
In an elderly woman who is not felt to be a good candidate for radical surgery is split course radiation alone an option for definitive intent radiati...
Margins negative. Discussion included adjuvant RT versus observation and/or repeat resection with recurrence.
Vulvar cancer is well differentiated. Closest margin is 6mm. LVI is identified
T1b N2c
Vaginal cancer treated 20 yrs ago described as 5 cm in length...
Sentinel Lymph Nodes negative
The patient had an initial partial vulvectomy and nodal dissection 6 years prior to recurrence, with no adjuvant RT offered initially due to lack of c...
Should these patients be managed similar to p16 positive anal squamous cell carcinoma, and allowed six months or more for complete regression before c...
Surgeon is not planning vulvectomy, since biopsies showed 2 mm depth of invasion.
Also tumor board felt dose to the primary site should be only about...
What would be factors that would indicate the need to include the pelvic nodes?
When should pelvic/inguinal lymph nodes be included?
Does this management depend on treatment site?
For definitive vulvar ca, is 5940 cGy the minimum acceptable dose for gross disease? 5760cGy? Or should the dose be escalated beyond 60Gy?