Stage IVa squamous cell carcinoma of the vulva managed with primary chemoradiation

We present the case of a 53-year-old woman with International Federation of Gynecology and Obstetrics stage IVa (T3N2M0) squamous cell carcinoma of the vulva. Because the urethra was surrounded by a vulvar tumor, she was managed with primary chemoradiation in an attempt to spare the morbidity associated with exenterative vulvar surgery. Treatment was given as a planned split course, consisting of two separate courses of 23.8 Gy each. During each split course of radiation, 5-fluorouracil, 1000 mg/m2 per day, was given over the first 4 days, and cisplatin 50 mg/m2 was administered as a single infusion on the first day. During the 4 days of chemotherapy infusion, the radiation was administered in two daily fractions of 1.7 Gy each, given at least 6 h apart. There was no treatment break due to adverse effect, and a pathological complete response was achieved in the primary tumor and the lymph nodes. The patient did not undergo surgical intervention, and has had no evidence of recurrence for 24 months. Chemoradiation therapy should be considered as an option in patients with locally advanced vulvar cancer to avert the need for exenterative surgery, and to preserve sexual, gastrointestinal, and urinary function.