Combined Therapy as an Alternative to Exenteration for Locally Advanced Vulvovaginal Cancer

Interstitial brachytherapy in the treatment of advanced and recurrent vulvar cancer

“…We acknowledge that these algorithms represent a departure from what has been considered "standard" therapy and, like Boronow et al, 18,19 accept the obligation to review our results periodically in subsequent communications.…”

“…The rationale was that the cancer and its dual regional spread patterns would be treated, while at the same time both the bladder and rectum would be preserved. During the succeeding years, Boronow et al 18,19 periodically reviewed their results and, at the time of their last published communication, had treated a total of 48 patients, with a projected overall 5-year survival rate of 72% for the study population. Certainly, the low incidence of clinically or pathologically involved inguinal-femoral lymph nodes among their cases contributed substantially to their impressive results.…”

“…This algorithm is based on the work of Boronow et al 3,18,19 with 1 modification: Interstitial irradiation is used in place of intracavitary irradiation to supply a radiation boost to the tumor-bearing region. Radical vulvectomy with bilateral inguinal lymphadenectomy to treat the external genital phase of the disease is followed by radiotherapy tailored to protect the surgical margins and treat the internal genital phase of the disease.…”

Neoadjuvant chemoradiotherapy followed by surgery in locally advanced squamous cell carcinoma of the vulva

“…Studies of neoadjuvant radiotherapy aiming to shrink lesions that would have otherwise required pelvic exenteration, have suggested that radiotherapy may be used to reduce the extent of subsequent surgery or eradicate the disease in certain patients (2)(3)(4). Furthermore, concomitant radiotherapy and chemotherapy with 5-fluorouracil (5-FU) improved regression of various squamous cell carcinomas of the anus, esophagus, head, neck and cervix (3). This lead to the investigation of the use of induction chemoradiation as the primary therapy for squamous cell carcinoma of the vulva.…”

Vulvakarzinom

“…Die Strahlentherapie allein ist aber meist nicht in der Lage, in diesen Fällen eine Tumorsterilisation zu erreichen. Als alternatives Konzept wurde die Kombination einer präoperativen Bestrahlung mit einer Salvage-Operation eingesetzt [6]. Dieses radiochirurgische Vorgehen beginnt mit einer intrakavitären resp.…”