Do you recommend adjuvant radiation for a recurrent pT1bN0 vulvar carcinoma?
What factors would push towards treatment? The patient had recurrence of a pT1bN0 vulvar SCC within a year of original surgery. Re-resection shows again a pT1bN0 lesion, negative margins. NCCN says observe vs EBRT. How do you decide?
Answer from: Radiation Oncologist at Community Practice
For recurrence disease, if the depth of invasion is more than 1 mm and nodal assessment is not done then would favor/discuss RT. Data shows with each recurrence, risk of nodal involvement (15%) goes up which is hard to salvage Grootenhuis et al., PMID 26428940.
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Answer from: Radiation Oncologist at Community Practice
Unfortunately, recurrent vulvar cancers have a poor prognosis with salvage radiotherapy. Early reports utilized radiation therapy often without chemosensitization and modern techniques. More modern retrospective series demonstrate salvage rates of approximately 20%. Laliscia et al., PMID 2...
Answer from: Radiation Oncologist at Academic Institution
Most true vulvar cancer recurrences (meaning disease along the post-op cavity, not a new primary within a separate portion of the vulva), even if re-excised, will have margins within 5 or 8 mm which is my usual threshold below which to recommend EBRT for LR benefit even in the upfront setting, albei...