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How do you approach pre-operative chemoradiation for vulvar cancer?
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 definitive chemoradiation (60-70 Gy). Presumably, this was done to strike a balance in achieving tumor downstaging prior to surgery, without additional toxicity and complications of resection from boosting to 70 Gy.
NCCN guidelines previously listed 57.6 Gy as the appropriate pre-operative dose for vulvar cancer, but this has been redacted in the most recent version 2.204.
How do you approach pre-operative chemoradiation for vulvar cancer both in terms of dose and contouring? Do you treat these differently from definitive cases, particularly if the extent of the disease is relatively limited (FIGO II)?