How long would a vulvar cancer s/p definitive chemoradiotherapy, how long should the lesion be followed for regression before initiating biopsy or salvage surgery?

There is no prospective data but our practice is to perform once the acute reactions subside, usually 6-8 weeks after chemo RT.

Our general practice is to perform a PET/CT and/or MRI 10-12 weeks following completion of definitive therapy. If there is concern for residual disease at this time point based on imaging and clinical exam, we would consider biopsy.

From a clinical viewpoint, what is interesting is that for anal cancers, we would routinely wait longer while for vulvar we do not. Yet both are often HPV related. While I would not advocate for waiting longer based on current data, I think individual clinical and patient factors must be weighed as these surgeries often are associated with prolonged healing and potential morbidity in a patient population that is often elderly with multiple co-morbidities.