ESTRO 2023

Session Item

Saturday

May 13

09:00 - 10:00

Stolz 1

Gynaecology

Chair: , The Netherlands;

Co-Chair: Safia Yahiaoui, Tunisia

Session Code: 1160

Session Type: Mini-Oral

Track: Clinical

Developing National Consensus Recommendations for Vulvar Cancer Radiotherapy Treatment.

Patricia Baird, United Kingdom

Presentation Number: MO-0053

Abstract

Abstract Title:

Developing National Consensus Recommendations for Vulvar Cancer Radiotherapy Treatment.

Authors:

Patricia Baird¹, Eleanor Dyke², Melanie Powell³, Alexandra Taylor⁴, Louise Hanna⁵, Ursula McGivern⁶, Jeffrey Summers⁷, Anupama Gore⁸, Audrey Cook⁹, Jennifer Forrest¹⁰, Alexandra Stewart¹¹

¹St Luke's Cancer Centre , Clinical Oncology , GUILDFORD, United Kingdom; ²St Luke’s Cancer Centre, Physics Department, GUILDFORD, United Kingdom; ³Barts Health NHS Trust, Clinical Oncology, London, United Kingdom; ⁴The Royal Marsden NHS Foundation Trust, Clinical Oncology, London , United Kingdom; ⁵Velindre University Hospital NHS Trust, Clinical Oncology, Cardiff, United Kingdom; ⁶Belfast City Hospital, Clinical Oncology, Belfast, United Kingdom; ⁷Maidstone and Tunbridge Wells NHS Trust, Clinical Oncology, Maidstone, United Kingdom; ⁸Leicester Royal Infirmary, Clinical Oncology, Leicester, United Kingdom; ⁹Gloucestershire Hospitals NHS Trus, Clinical Oncology, Gloucester, United Kingdom; ¹⁰Royal Devon University Hospital Trust, Clinical Oncology, Exeter, United Kingdom; ¹¹Saint Luke's Cancer Centre , Clinical Oncology, GUILDFORD, United Kingdom

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Purpose or Objective

The UK vulvar cancer audit showed the widespread use of IMRT in the UK with minimal organ toxicity. However, there was considerable dose range variation with no UK consensus regarding the minimum dose to improve local control (1). The international consensus guidelines for the contouring and treatment of vulvar cancer do not reflect UK practice (2).We aimed to develop recommendations to deliver consistent RT treatment of vulvar cancer in the UK with greater standardisation of dose prescribing and reporting.

Material and Methods

The Royal College of Radiologists (RCR) invited a group of gynaecology Clinical Oncology experts to develop consensus recommendations. Draft guidelines were written using the outcomes of the 2019/2020 RCR national vulvar cancer radiotherapy audit. The Consensus group then refined the guidelines through regular meetings and discussions, using a modified Delphi process. The RCR hosted an online contouring exercise where a second expert panel contoured two vulvar cancer cases (radical radiotherapy alone and post-operative nodal fields) before and after reading the consensus recommendations. Further changes were made and the draft recommendations were presented at a British Gynaecological Cancer Society workshop after which final changes were made.

Results

Consensus recommendations define volumes to contour (table 1) with structured contouring guidelines containing example images. Figure 1 recommends dose/fractionation schemes. Guidance is also given regarding treatment planning, dosimetric parameters and care on treatment.

Table 1

Figure 1

Conclusion

We believe these recommendations will standardise the RT treatment of vulvar cancer in the UK. We also aim to improve compliance with national recommendations such as the treatment of vulvar cancer as category 1 and compensation of gaps during treatment. The national RCR audit will be repeated in 2024 to assess the impact of these recommendations on UK practice.

References

1. Baird P DK, Forrest J, Stewart A “The Royal College of Radiologists National Vulvar Cancer Audit”. 2022.

2. Gaffney DK, King B, Viswanathan AN, Barkati M, Beriwal S, Eifel P, et al. Consensus Recommendations for Radiation Therapy Contouring and Treatment of Vulvar Carcinoma. Int J Radiat Oncol Biol Phys. 2016;95(4):1191-200.DOI: 10.1016/j.ijrobp.2016.02.043.