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

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

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...