Page 8 - Vulvar Cancer Guidelines Summary fxd

RADIATION THERAPY

✓ 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 con-
sidered 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 the 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.

CHEMORADIATION

C Definitive chemoradiation (with radiation dose escalation) is the treatment of choice in patients

with unresectable disease.

C In advanced stage disease, neoadjuvant chemoradiation should be considered in order to avoid

exenterative surgery.

C Radiosensitising chemotherapy, preferably with weekly cisplatin, is recommended.

SYSTEMIC TREATMENT

D Data in vulvar cancer are insufficient to recommend a preferred schedule in a palliative setting.

6 • VULVAR CANCER - GUIDELINES •