How would you manage a bulky primary exophytic vulvar SqCC in a patient with uncontrolled but very long standing HIV disease?

The patient is a female in her 60s, HIV+ since age 19, and has a current CD4 total count of 20. She has a 7 cm primary cancer without involvement of vaginal mucosa but has urethra involvement. She has palpable bilateral inguinal adenopathy and FDG avid left iliac adenopathy. If chemotherapy is not deemed safe for her, how would you approach her treatment?

2 Answers

Mednet MemberInvited Expert

Radiation Oncology · Varian Medical Systems/Allegheny health network

Answered on

I would first optimize HIV management and then plan for definitive RT (chemo) based on the CD4 count.

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Mednet Member

Radiation Oncology · Vanderbilt-Ingram Cancer Center

Answered on

Agree to optimize her HIV management. CD4 of 20 is (most likely) not optimized. Treating a patient, even with RT alone, who is in active AIDS (CD4 < 200) would be suboptimal.

Once her CD4 count can be raised over 200, the question of how to best manage her malignancy can be considered.

Does the pati...

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