| Summary: | This case report describes a complex radical 3D-Conformal Radiotherapy treatment
planning, dosimetric issues and outcome of definitive treatment of un-resectable carcinoma of
the vulvar in a 42-year old lady. The patient presented with large fungating mass of the vulva
which was biopsy confirmed as Keratinizing Squamous Cell Carcinoma. Further staging
investigation revealed locally advanced disease (T4), with bilateral inguinal lymph nodes
involvement. There is no systemic metastasis or intra-pelvic nodes. The patient was seen by
Gynae-Oncology team and the disease was deemed un-resectable without significant morbidity.
She was treated to a total dose of 64.8Gy in 36 fractions over 7 weeks with concurrent weekly
Cisplatinum in 2 phases. 3D-Conformal radiotherapy technique using the modified segmental
boost technique (MSBT, large PA and small AP photon fields with inguinal electron matching)
was used. TLD chips were used for in-vivo dose verification in phase 1 and 2 of the treatment.
At completion of planned radiotherapy, patient had a complete clinical response, grade 2-3 skin
toxicity, grade 2 rectal toxicity, and grade 2 dysuria Vulval Squamous Cell Carcinomas are very
radiosensitive tumours and the skills of the treating Radiation Oncologist, Dosimetrists,
Physicist, Radiation Therapist and also nurses is of foremost importance is ensuring good clinical
outcomes.
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