Few treatments are more difficult than definitive chemoradiation for locally advanced vulvar cancer. This small prospective series assessed dosimetric advantages when replanning to smaller target volumes after delivery of the initial 30-36 Gy. All 20 enrollees had a plan generated using pre-treatment PET with a prescription of 45-56 Gy to elective nodes followed by a sequential boost to gross disease to a total of 64-66 Gy all at 1.8 Gy per fraction via IMRT with concurrent weekly cisplatin. Organs at risk and target volumes were then revised with a re-simulation and re-staging PET after 30-36 Gy. While modest, there were statistically significant reductions in maximum dose to bladder and bowel of approximately 1 Gy and of rectal D2cc of 0.5 Gy. Local control at 2 years was 63% and in line with historical standards. | Shenker, Adv Radiat Oncol 2023
