Table 4.
Suggested doses to the vulva, nodal elective volume, and nodal boost
| Vulva GTV dose | Elective nodes | Nodal boost | |
|---|---|---|---|
| Postoperative radiation | |||
| Negative margins and no ECE | 5040-5120 cGy | 5040-5120a cGy | None |
| Vulva positive margin | 6000 cGy | 5040-5120a cGy | None |
| Node with ECE | 5040-5120 cGy | 5040-5120a cGy | 6000 cGy |
| Definitive radiation | |||
| No brachytherapy | 6000-7000b cGy | 5040-5120a cGy | 6600c cGy |
| With brachytherapy | 6000b cGy (IMRT) + 1200d cGy (BT) | 5040-5120a cGy | 6600c cGy |
BT, brachytherapy; ECE, extracapsular extension; GTV, gross tumor volume; IMRT, intensity modulated radiation therapy.
a
Dose per fraction of the elective volumes are adjusted to maintain 200 cGy per fraction in the integrated boost volume.
b
Consider increased dose to vulva tumor GTV of 6600 or 7000 cGy for large tumors.
c
Consider higher dose of 7000 cGy for large lymph nodes.
d
Consider brachytherapy dose of 1600 cGy or higher if residual disease is present after IMRT.