Vaginal cancer

Abstract

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.

Definitive Radiotherapy for Primary Squamous Cell Carcinoma of the Vagina: Are High-Dose External Beam Radiotherapy and High-Dose-Rate Brachytherapy Boost the Best Treatment? Experience of Two Italian Institutes

“…Total tumor dose as a continuous parameter and technique of therapy (EBRT alone and EBRT + intracavitary RT) were significant prognostic factors by univariate analysis (p < 0.05). A review of literature on 17 studies showed a cumulative 5-year survival ranging from 0% to 80% for patients with FIGO stage III vaginal carcinoma treated with RT alone [23]. Combination of EBRT and BT was the most commonly used treatment in this clinical setting.…”

Squamous cell carcinoma of the vagina: natural history, treatment modalities and prognostic factors

“…Due to the anatomy of the region and the close proximity of the vagina to critical pelvic structures such as the bladder, urethra and rectum, surgery has a limited role in the management of vaginal carcinoma [1,6,[42][43][44][45][46][47]. The standard treatment is radiotherapy, which utilizes external beam radiation [EBRT] and/or brachytherapy [BT] techniques [6,22,[48][49][50][51][52][53][54][55][56][57][58][59][60][61].…”

“…Nowadays, surgery can be taken into consideration in accurately selected cases of: (i) stage I disease confined to the upper posterior vagina; (ii) stage IV disease with recto-vaginal or vesico-vaginal fistula; (iii) central recurrence after radiotherapy [1,6,42,44,45,47,[69][70][71]. As far as the patients with stage I disease are concerned, surgery consists of radical hysterectomy, upper vaginectomy and pelvic lymphadenectomy if the uterus is still in situ, and radical upper vaginectomy and pelvic lymphadenectomy if the uterus has been previously removed.…”

Institutional experience using interstitial brachytherapy for the treatment of primary and recurrent pelvic malignancies

“…Brachytherapy is essential for management of primary vaginal cancer where radical surgery is often precluded by significant morbidity [1,2]. Patients with vaginal recurrence of pelvic tumors such as endometrial cancer are infrequently candidates for repeat surgical excision [3], however combination BT and EBRT provides excellent long-term control and is a potentially curative option in localized disease [4,5,6].…”