Concurrent radiation therapy and chemotherapy in the treatment of primary squamous cell carcinoma of the vulva

Abstract

Background. Interest in combined modality treatment and in quality of life issues may affect the choice of radical vulvectomy as the treatment of choice in many vulvar carcinomas. To evaluate the potential role of combined radiation and chemotherapy with or without local excision as primary treatment for squamous cell carcinoma of the vulva, the outcomes of 19 patients with this disease treated with combination therapy were reviewed. Methods. Nineteen patients were treated between September 1987 and October 1992. Fifteen patients had American Joint Committee on Cancer Stage III disease; 4 had Stage II. All had clinically negative inguinal lymph nodes with the exception of two patients who had positive ipsilateral inguinal nodes that were removed before treatment. The patients received 45‐50 Gy to the pelvis and inguinal nodes with concurrent chemotherapy that consisted of 5‐fluorouraciI given as a 96‐hour continuous infusion (1000 mg/m2/d) during weeks 1 and 5 of radiation. A single dose of mitomycin‐C (10 mg/m2) during the first day of chemotherapy has been used since November 1991. Ten patients were boosted with implants or electrons and 6 others underwent local excision. Results. The median follow‐up was 34 months. Responses were determined clinically 1 month after completion of the radiation and chemotherapy. Clinically, complete responses were obtained in 10 patients (53%), partial responses in 7 (37%), and no response in 1; 1 patient progressed during treatment. The combined modality therapy (radiation/chemotherapy/with or without wide local excision) resulted in a local control rate of 74% (14/19). All five treatment failures occurred within 6 months of treatment. Four of these patients were rendered disease free by radical vulvectomy and/or exenteration, for an overall local control rate of 95% (18/19). Conclusion. Concurrent radiation therapy and chemotherapy with local excision performed as needed, appears to be a reasonable alternative to radical vulvectomy in patients with primary squamous cell carcinoma of the vulva. Radical surgery remains a viable option for patients in whom primary therapy has failed.

Surgery and radiotherapy in vulvar cancer

“…Radiotherapy with or without chemotherapy has also proven its efficacy in the treatment of vulvar cancer. Collated literature data show a somewhat lower local control rate of 40% after chemoradiotherapy compared with surgery [128][129][130][131][132][133][134] (Table 5). Radiotherapy in moderate doses combined with chemotherapy, followed by organ sparing surgery has shown its efficacy in preventing stoma formation [135].…”

Interstitial brachytherapy in the treatment of advanced and recurrent vulvar cancer

“…Both single-institution experiences and preliminary results from the ongoing Gynecologic Oncology Group Protocol 101 cooperative trial have been encouraging. [20][21][22][23][24] External beam therapy with synchronous radiopotentiating chemotherapy (usually 5-fluorouracil) may obviate the need for exenteration or extensive surgery in patients whose medical conditions preclude surgery. Although the responses are usually prompt and dramatic, they are often not sustained.…”

“…Designed around the accumulating experience in the use of radiosensitizing agents in the management of locally advanced vulvar cancer, [20][21][22][23][24] this algorithm consists of bilateral groin node dissection of enlarged, mobile nodes, followed by chemoradiation (eg, cisplatin or 5-fluorouracil and external beam radiotherapy) and an interstitial brachytherapy boost to the vulva. Algorithm 3: Matted or fixed inguinofemoral lymph nodes.…”

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

“…A number of retrospective analyses have established the feasibility of this new therapeutic approach, and suggested a therapeutic benefit of induction chemoradiation therapy for the treatment of vulvar neoplasms (2,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). The majority of studies involved patients with locally advanced vulvar neoplasms, but certain studies also included recurrent tumor cases that were not eligible for surgical resection by radical vulvectomy.…”