How would you manage a patient diagnosed with squamous carcinoma involving the entire length of the vagina and extends into the vulva (introitus), who has severe vaginal stenosis?
She required an episiotomy intraoperatively just to perform an EUA/biopsy. She may not tolerate vaginal cylinder insertion and even if she can, I am uncertain if VBT would adequately cover her disease.
Answer from: Radiation Oncologist at Academic Institution
If brachy (including interstitial) is not an option, sometimes we have used straight tandem with a diameter less than a cm instead of cylinder to do brachy with stenosis.
If that is also not an option then would do an IMRT boost to a total dose in the 70s based on OAR dose.
Answer from: Radiation Oncologist at Academic Institution
If this is a vaginal lesion involving the vulva, it should be classified as vulva cancer and treated like so.
Typically with ext beam boost to 66 to 70 Gy.
Comments
Radiation Oncologist at Allegheny Health Network Does she have a cervix/uterus still? If yes, MRI m...
Answer from: Radiation Oncologist at Academic Institution
Based on the response to EBRT, there may be a role for interstitial brachytherapy. It may be easier to place a cylinder under anesthesia plus a few perineal needles.
Answer from: Radiation Oncologist at Community Practice
I would treat this extensive vulvar cancer with full dose IMRT and low dose cisplatin. Would utilize brachytherapy with a tandem and small sleeves as for a cervix patient with a narrow canal if possible. Interstitial is an option but really dependent on the extent of disease by MRI. I would favor le...
Answer from: Radiation Oncologist at Community Practice
Thanks for everyone's input. Her case is complicated by the fact that she has refused chemotherapy and declined consideration of interstitial therapy. Lastly, she is very thin with a prior history of hysterectomy (benign reasons). As a result, small bowel is essentially throughout the low pelvis and...
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Radiation Oncologist at Allegheny Health Network If/when you get to the boost phase of treatment, i...