Vulvar Cancer

نکته های پراکنده:

RT groin vs surgery —> less toxicity but more recurrence ( cochrane review )

Dose and Fractionation:

  • Postoperative setting
    • Microscopic dose: 4,500 to 5,000 cGy with a fraction size of 180 to 200 cGy
    • High-risk features are present
      • ECE
      • +margins
    • then: Dose escalation or the addition of concurrent chemo may be considered with acknowledgment of differing associated morbidity.
  • Pre-operative chemoradiotherapy GOG trial:
    • 4,760 cGy and the upcoming GOG trial escalating dose to 5,760 cGy will provide 2 points on the dose-control curve and help us to determine more precisely the dose required to eradicate macroscopic disease and potentially eliminate the need for radical node dissection.
    • The concurrent chemotherapy agents being used are 5-FU, cisplatin, and mitomycin-C.
  • When treating with definitive chemoradiation:
    • 180-cGy fractions when treating the nodes alone
    • Reduced fraction size of 160 to 170 cGy when the vulva is included in the treatment volume to minimize the risk of late effects
    • Total dose is 6,200 to 6,400 cGy
    • Twice-per-day treatments days 1 to 4 in weeks 1, 3, 6, with concurrent infusional 5-FU over 96 hours during the twice-per-day radiation.

  • Indication of adj RT to nodal area after gross nodal dissection
    • >1 inguinal node
    • ECE
    • Gross residual nodal disease
  • Dose
    • 45 – 50 Gy
    • both groins & pelvis
    • Significant survival benefit in a RCT
    • Patients having single node metastasis without extracapsular spread should not be considered for adjuvant RT