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?   

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.

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.

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. 

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...

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...