What is your recommended radiation field in early stage vulvar cancer (T1a-b) with myelosuppression, inconclusive SLNBx, and persistent positive margins?

Would favor vulva and bilateral groin (limit to medial groin to reduce marrow exposure of femoral region).

pT1a with persistently positive margins wouldn't recommend even inguinal RT, just treat vulva. Those patients don't even necessarily need an inguinal nodal evaluation.

pT1b - If no radiographic suspicion, could consider sending the patient for IFLND of the relevant side, and if negative, treat vulva...