Locally Advanced or Unresectable Vulvar Cancer After Chemoradiotherapy Without Complete Remission
This protocol addresses the management of squamous cell carcinoma of the vulva that is locally advanced (clinical ≥T3 and/or ≥N2), unresectable, or would otherwise require exenterative surgery with stoma formation — specifically in the setting where primary chemoradiotherapy has not resulted in complete tumor remission.
Clinical Scenario
Patients present with locally advanced vulvar squamous cell carcinoma — defined as clinical stage ≥T3 and/or ≥N2 — or with unresectable disease, including tumors where surgical resection would otherwise necessitate exenterative procedures with stoma formation. Primary chemoradiotherapy is the standard initial approach for this population.
Why This Protocol Is Needed: Prior Treatment Did Not Achieve Its Goal
The previous treatment line — primary (definitive) chemoradiotherapy — was directed at achieving complete remission of the vulvar tumor, assessed at 12 weeks after completion of treatment. This protocol is indicated when that goal of complete remission has not been met.
Next-Step Treatment Approach (Partial Overview)
A surgical intervention targeting residual disease is a key consideration at this stage.
Full eligibility criteria, sequencing, and procedural details are in the complete protocol.
References
DOI: 10.1136/ijgc-2023-004486
- Primary chemoradiotherapy is the treatment of choice in patients with unresectable disease and should be considered for tumors which would otherwise need exenterative surgery with stoma formation [III, B].
- Throughout these recommendations, advanced stage of disease is defined as clinical ≥T3 and/or ≥N2 [V, B].
- In case of residual disease surgery should be considered [III, B].
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