How do you approach pre-operative chemoradiation for vulvar cancer?

Topics: Radiation Oncology • Gynecologic Cancers • 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)?

Answer from: Radiation Oncologist at Community Practice

Over time, the approach shifted from administering preoperative doses to delivering more doses in the mid-60s. Biopsies are now conducted at 8-12 weeks for persistent abnormalities to define pCR and persistent disease, thus enabling tailored management (Richman et al., PMID 32981696).Also this abstr...

Answer from: Radiation Oncologist at Academic Institution

Based on my experience over a 40-year career, I believe that pre-op RT in locally advanced vulvar cancer is an important treatment option that should not be discarded. Clearly, some patients are not going to be curable with chemo-RT alone based on volume of disease. And waiting 3 months to do a biop...

Answer from: Radiation Oncologist at Academic Institution

We don't really do pre-operative chemoRT anymore. If a patient is not deemed a candidate for upfront resection, we attempt to cure them with a completely non-surgical approach and consider biopsy of residual abnormalities as Dr. @Beriwal mentions.I am not aware of surgical data differentiating diffe...

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