Vaginal Contouring Guidelines for Radiation Therapy

Target Volume Definition and Contouring

The National Comprehensive Cancer Network recommends that the vulvar clinical target volume (CTV) should be defined as the gross tumor volume (GTV) or tumor bed plus the adjacent skin, mucosa, and subcutaneous tissue of the vulva excluding bony tissue, with a wire placed clinically to define the vulvar skin borders during CT simulation 1
Any gross vulvar disease should be contoured as a GTV and include any visible and/or palpable extension into the vagina 3
The vulvar CTV target should exclude bony tissue while including the GTV or tumor bed plus adjacent skin, mucosa, and subcutaneous tissue 1

The National Comprehensive Cancer Network suggests that CT or MRI planning with possible image fusion technology should be used to ensure adequate dosing and coverage 5
Radio-opaque markers should be placed on key landmarks during simulation to assist in defining the primary target volume 5
Doses to target areas should be confirmed using thermoluminescent dosimeter (TLD) at the first treatment 2

The National Comprehensive Cancer Network recommends that the inguinofemoral nodal CTV should extend laterally from the vessels to the medial border of the sartorius and rectus femoris muscles, posteriorly to the anterior vastus medialis muscle, medially to the pectineus muscle or 2.5-3 cm medially from the vessels, and anteriorly to the anterior border of the sartorius muscle 3
The caudal extent of the inguinofemoral nodal basin is the top of the lesser trochanter of the femur 3

The National Comprehensive Cancer Network suggests that the groin CTV volume should not extend outside the skin and should be trimmed by 3 mm in the absence of skin involvement 4
Planned treatment volume (PTV) expansion is typically 7-10 mm 4

The National Comprehensive Cancer Network recommends that planning should respect normal tissue tolerances including rectum, bladder, small bowel, and femoral head and neck 5
Bolus should be used to ensure adequate dosing to superficial target volumes 1
Doses range from 50.4 Gy in 1.8 Gy fractions for adjuvant therapy to 59.4-64.8 Gy in 1.8 Gy fractions for unresectable disease 6

Patients who have received RT for vulvar cancer may experience vaginal stenosis and dryness 7
Vaginal dilators may be beneficial for patients experiencing symptoms of vaginismus and/or vaginal stenosis 8
The National Comprehensive Cancer Network recommends that patients should receive education on sexual health and vaginal health, including regular vaginal intercourse and/or vaginal dilator use 7