Summary of Recommendations
- Adjuvant treatment is recommended when surgical margins of the primary are < 8 mm or when positive lymph nodes are identified.
- Sentinel lymph node biopsy is an adequate pathologic assessment of the lymph nodes for patients with clinically negative lymph nodes and primary vulvar tumors < 4–6 cm.
- When treating for close or positive margins, radiation dose to the primary tumor bed should reach 56 Gy when tolerable.
- When groin nodes are involved, the involved nodal region and the pelvic nodal region should be treated. Radiation dose should be approximately 45–50 Gy if no extranodal extension is noted. With extranodal extension, the nodal region should be treated with > 56 Gy.
- Consider adjuvant chemotherapy with bulky nodal disease and extranodal extension, although toxicity may be increased compared to radiation therapy alone.