Background: Primary prevention through vaccination is a prophylactic approach aiming to reduce the risk of developing human papillomavirus (HPV)-related lesions. No mature and long-term data supported the adoption of vaccination in women undergoing conization. Methods: This is a retrospective multi-institutional study. Charts of consecutive patients undergoing conization between 2010 and 2014 were collected. All patients included had at least 5 years of follow-up. We compared outcomes of patients undergoing conization plus vaccination and conization alone. A propensity-score matching algorithm was applied in order to reduce allocation biases. The risk of developing recurrence was estimated using Kaplan-Meir and Cox hazard models. Results: Overall, charts of 1914 women were analyzed. The study group included 116 (6.1%) and 1798 (93.9%) women undergoing conization plus vaccination and conization alone, respectively. Five-year recurrence rate was 1.7% (n = 2) and 5.7% (n = 102) after conization plus vaccination and conization alone, respectively (p = 0.068). After the application of a propensity-score matching, we selected 100 patients undergoing conization plus vaccination and 200 patients undergoing conization alone. The crude number of recurrences was 2 (2%) and 11 (5.5%) for patients undergoing conization plus vaccination and conization alone, respectively (p = 0.231). Vaccination had no impact on persistent lesions (no negative examination between conization and new cervical dysplasia; p = 0.603), but reduced the risk of recurrent disease (patients who had at least one negative examination between conization and the diagnosis of recurrent cervical dysplasia; p = 0.031). Conclusions: Patients having vaccination experience a slightly lower risk of recurrence than women who had not, although not statistically significantly different. Further evidence is needed to assess the cost effectiveness of adopting vaccination in this setting.

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Because of the low incidence of vaginal cancer, phase III trials have not been carried out and current guidelines have been drawn on retrospective studies. This state of affairs explains the variety of treatments to which women affected by this disease are subjected to. In this article, we report the current results achieved by different therapeutic strategies. The primary treatment options in Stage I vaginal carcinoma are surgery and/or radiotherapy. For a small tumor, a wide excision can be used. For high risk patients, a more aggressive surgery is mandatory. The most frequently adopted treatment strategy for Stage II is a combination of brachytherapy and EBRT. Selected patients may be treated by radical surgery. Neoadjuvant chemotherapy followed by radical surgery is a valid alternative to the standard treatment in terms of survival. Combination of EBRT and brachytherapy is the most commonly adopted treatment in stages III-IV A and, in selected patients, pelvic exenteration or a combination of irradiation and exenteration can be used.