The Air Out There: Treatment Planning When Target Volumes Extend Beyond the Skin

A patient presented with squamous cell carcinoma of the vulva, pT2pN2c, stage IIIC status post radical vulvectomy and bilateral groin dissection. The pathology report revealed close and positive margins and lymphovascular space invasion at the primary site, as well as multiple positive lymph nodes with extracapsular extension. The patient was simulated head-first supine in the frog-legged position, with the assistance of a custom immobilization device. Simulation also included 5 mm of water-equivalent bolus applied to the right groin, corresponding to a region suspicious for positive nodes and extracapsular extension.

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