Last time we built the algorithm for early vulvar cancer—who needs nodes, how sentinel mapping changes the plan, and when to radiate the vulvar bed and groins. Today we turn to the hard one: locally advanced, unresectable disease. We’ll start by defining “unresectable,” walk through the neoadjuvant chemoradiation evidence, and then do a planning workshop you can take straight to clinic: how to contour the inguinofemoral basins without the classic medial miss, how to set doses for elective versus high-risk volumes, and why you should not “midline-block” the vulva when you’re treating positive nodes. We’ll reinforce, repeat where it helps, and keep it board-ready.

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