Page 33 - ESGO - Vulvar cancer - Complete report_fxd2

11.3 Development group comments

When possible without damaging structures such as anus, urethra and clitoris, reexcision is preferred in case of
positive margins in the light of the significant short as well as long term morbidity associated with the necessary
relatively high dose of radiotherapy to the vulvar skin.

11.4 Guidelines

 Adjuvant radiotherapy should start as soon as possible, preferably within 6 weeks of surgical treatment.
 When invasive disease extends to the pathological excision margins of the primary tumour, and further

surgical excision is not possible, postoperative radiotherapy should be performed.
 In case of close but clear pathological margins, postoperative vulvar radiotherapy may be considered to

reduce the frequency of local recurrences. There is no consensus for the threshold of pathological
margin distance below which adjuvant radiotherapy should be advised.
B Postoperative radiotherapy to the groin is recommended for cases with > 1 metastatic lymph node
and/or presence of extracapsular lymph node involvement.
 Adjuvant radiotherapy for metastatic groin nodes should include the ipsilateral groin area and where
pelvic nodes are non-suspicious on imaging, the distal part of the iliac nodes with an upper limit at the
level of the bifurcation of the common iliac artery.
C Based on evidence from other squamous cell cancers such as cervical, head & neck, and anal cancer,
the addition of concomitant, radiosensitising chemotherapy to adjuvant radiotherapy should be
considered.

 VULVAR CANCER - GUIDELINES 
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