Adjuvant RT for SCC of the vulva

[Kroll2013]

Dear friends,
I have a 68 yo lady (diabetic and has hypertension) that was diagnosed of right vulvar SCC grade 1, pT1bpN0.
4cm lesion, 1cm Depth of invasion, no LVSI, all margins are negative > 8 mm except for urethral margin which is at 7 mm.
What do you do next:
1- observation
2- adjuvant RT to vulvar tumor bed only
3- adjuvant RT to pelvis only
4- adjuvant RT to pelvis and vulvar tumor bed

Ty




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[seper]

It's a toss-up. Her local recurrence risk is 15-20%. Many will observe, many will treat with a local field only.

 

[Palex80]

pN0 is based on sentinel lymph node dissection, I presume?

Her main risk factor for recurrence is the depth of invasion. I wouldn't be all too worried about the margins, there are contemporary reports showing a small risk of recurrence with margins around 5mm.

I'd observe.

 

[OliveTree]

It's a toss-up. Her local recurrence risk is 15-20%. Many will observe, many will treat with a local field only.

Are you using a nomogram?

 

[seper]

No, I don't think there is a good one for vulvar tumor recurrence.

Are you using a nomogram?