Current Treatment Options in Oncology

, Volume 5, Issue 2, pp 85–95 | Cite as

Carcinoma of the vulva: Combined modality treatment

  • Gustavo S. Montana

Opinion statement

One of the most significant developments in recent decades in the management of malignant diseases is the recognition that surgery, radiation, and chemotherapy have limited curative potential. Along with this recognition has come the realization that although some patients can be cured with one of these modalities alone, the judicious combination of these modalities can result in better outcome. Carcinoma of the vulva, a disease that presents challenges with its management because of its anatomic location, affinity for spread to the lymph nodes, and incidence in elderly patients, lends itself to the use of this multimodality approach. The specific purpose of this approach is to decrease the sequelae of radical surgery. In addition, patients that could not be considered candidates for any treatment, such as patients with unresectable nodes, can be offered therapy with potential of cure. The patients with moderately or very advanced disease should be considered for the combination of chemotherapy, radiation, and surgery. This combined therapy results in better outcome with lesser morbidity. The studies that have been carried out in recent years for patients with advanced carcinoma of the vulva have helped to establish treatment guidelines that can be followed with confidence until more information becomes available.


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References and Recommended Reading

  1. 1.
    Ries LG, Pollack ES, Young JL Jr: Cancer patient survival: Surveillance, Epidemiology, and End Results Program, 1973–79. J Natl Cancer Inst 1983, 70:693–707.PubMedGoogle Scholar
  2. 2.
    van der Velden J, van Lindert AC, Gimbrere CH, et al.: Epidemiologic data on vulvar cancer: comparison of hospital with population-based data. Gynecol Oncol 1996, 62:379–383.PubMedCrossRefGoogle Scholar
  3. 3.
    Sturgeon SR, Brinton LA, Devesa SS, Kurman RJ: In situ and invasive vulvar cancer incidence trends (1973 to 1987). Am J Obstet Gynecol 1992, 166:1482–1485.PubMedGoogle Scholar
  4. 4.
    Abell MR, Goslin JR: Intraepithelial and infiltrative carcinoma of vulva: Bowen’s type. Cancer 1961, 14:318–329.PubMedCrossRefGoogle Scholar
  5. 5.
    Choo YC, Morley GW: Double primary epidermoid carcinoma of the vulva and cervix. Gynecol Oncol 1980, 9:324–333.PubMedCrossRefGoogle Scholar
  6. 6.
    Pilotti S, Rotola A, D’Amato L, et al.: Vulvar carcinomas: search for sequences homologous to human papillomavirus and herpes simplex virus DNA. Mod Pathol 1990, 3:442–448.PubMedGoogle Scholar
  7. 7.
    Perez CA, Grigsby PW, Brady LW: Principles and Practice of Radiation Oncology. Philadelphia: Lippincott-Raven; 1997.Google Scholar
  8. 8.
    Homesley HD, Bundy BN, Sedlis A, Adcock L: Radiation therapy versus pelvic node resection for carcinoma of the vulva with positive groin nodes. Obstet Gynecol 1986, 68:733–740.PubMedGoogle Scholar
  9. 9.
    de Hullu JA, Hollema H, Piers DA, et al.: Sentinel lymph node procedure is highly accurate in squamous cell carcinoma of the vulva. J Clin Oncol 2000, 18:2811–2816. Sentinel node biopsies can spare patients the immediate postoperative and the late morbidity of inguinal-femoral node dissections. The information regarding the status of the inguinal-femoral nodes is also useful to address considerations for therapy of the pelvic lymph nodes.PubMedGoogle Scholar
  10. 10.
    Taussig FJ: Cancer of the vulva: an analysis of 155 cases (1911–1940). Am J Obstet Gynecol 1948, 40:764–769.Google Scholar
  11. 11.
    Dusenbery KE, Carlson JW, LaPorte RM, et al.: Radical vulvectomy with postoperative irradiation for vulvar cancer: therapeutic implications of a central block. Int J Radiat Oncol Biol Phys 1994, 29:989–998.PubMedGoogle Scholar
  12. 12.
    Lanciano RM, Corn BW: Groin irradiation for vulvar cancer: treatment planning must do more than scratch the surface. Int J Radiat Oncol Biol Phys 1993, 27:469–474.Google Scholar
  13. 13.
    Faul CM, Mirmow D, Huang Q, et al.: Adjuvant radiation for vulvar carcinoma: improved local control. Int J Radiat Oncol Biol Phys 1997, 38:381–389.PubMedCrossRefGoogle Scholar
  14. 14.
    Rooney M, Kish J, Jacobs J, et al.: Improved complete response rate and survival in advanced head and neck cancer after three-course induction therapy with 120-hour 5-FU infusion and cisplatin. Cancer 1985, 55:1123–1128.PubMedCrossRefGoogle Scholar
  15. 15.
    Brizel DM, Albers ME, Fisher SR, et al.: Hyperfractionated irradiation with or without concurrent chemotherapy for locally advanced head and neck cancer. N Engl J Med 1998, 338:1798–1804.PubMedCrossRefGoogle Scholar
  16. 16.
    Martenson JA, Lipsitz SR, Wagner H Jr, et al.: Initial results of a phase II trial of high dose radiation therapy, 5-fluorouracil, and cisplatin for patients with anal cancer (E4292): an Eastern Cooperative Oncology Group study. Int J Radiat Oncol Biol Phys 1996, 35:745–749.PubMedCrossRefGoogle Scholar
  17. 17.
    Phillips B, Buchsbaum HJ, Lifshitz S: Pelvic exenteration for vulvovaginal carcinoma. Am J Obstet Gynecol 1981, 141:1038–1044.PubMedGoogle Scholar
  18. 18.
    Andersen BL, Hacker NF: Psychosexual adjustment after vulvar surgery. Obstet Gynecol 1983, 62:457–462.PubMedGoogle Scholar
  19. 19.
    Andersen BL, Hacker NF: Psychosexual adjustment following pelvic exenteration. Obstet Gynecol 1983, 61:331–338.PubMedGoogle Scholar
  20. 20.
    Boronow R: Combined therapy as an alternative to exenteration for locally advanced vulvo-vaginal cancer: rationale and results. Cancer 1982, 49:1085–1091.PubMedCrossRefGoogle Scholar
  21. 21.
    Hacker NF, Berek JS, Juillard GJ, Lagasse LD: Preoperative radiation therapy for locally advanced vulvar cancer. Cancer 1984, 54:2056–2061.PubMedCrossRefGoogle Scholar
  22. 22.
    Akl A, Akl M, Boike G, et al.: Preliminary results of chemoradiation as a primary treatment for vulvar carcinoma. Int J Radiat Oncol Biol Phys 2000, 48:415–420. This study is small, but the results are excellent. In this series, the patients had less advanced disease. The radiation treatment was directed to the vulvar area only.PubMedCrossRefGoogle Scholar
  23. 23.
    Han SC, Kim DH, Higgins SA, et al.: Chemoradiation as primary or adjuvant treatment for locally advanced carcinoma of the vulva. Int J Radiat Oncol Biol Phys 2000, 47:1235–1244.PubMedCrossRefGoogle Scholar
  24. 24.
    Cunningham MJ, Goyer RP, Gibbons SK, et al.: Primary radiation, cisplatin, and 5-fluorouracil for advanced squamous carcinoma of the vulva. Gynecol Oncol 1997, 66:258–261.PubMedCrossRefGoogle Scholar
  25. 25.
    Landoni F, Maneo A, Zanetta G, et al.: Concurrent preoperative chemotherapy with 5-fluorouracil and mitomycin C and radiotherapy (FUMIR) followed by limited surgery in locally advanced and recurrent vulvar carcinoma. Gynecol Oncol 1996, 61:321–327.PubMedCrossRefGoogle Scholar
  26. 26.
    Lupi G, Raspagliesi F, Zucali R, et al.: Combined preoperative chemoradiotherapy followed by radical surgery in locally advanced vulvar carcinoma: a pilot study. Cancer 1996, 77:1472–1478.PubMedCrossRefGoogle Scholar
  27. 27.
    Eifel PJ, Morris M, Burke TW, et al.: Prolonged continuous infusion cisplatin and 5-fluorouracil with radiation for locally advanced carcinoma of the vulva. Gynecol Oncol 1995, 59:51–56.PubMedCrossRefGoogle Scholar
  28. 28.
    Wahlen SA, Slater JD, Wagner RJ, et al.: Concurrent radiation therapy and chemotherapy in the treatment of primary squamous cell carcinoma of the vulva. Cancer 1995, 75:2289–2294.PubMedCrossRefGoogle Scholar
  29. 29.
    Sebag-Montefiore DJ, McLean C, Arnott SJ, et al.: Treatment of advanced carcinoma of the vulva with chemoradiotherapy: can exenterative surgery be avoided? Int J Gynecol Cancer 1994, 4:150–155.PubMedCrossRefGoogle Scholar
  30. 30.
    Koh WJ, Wallace HJ 3rd, Greer BE, et al.: Combined radiotherapy and chemotherapy in the management of local-regionally advanced vulvar cancer. Int J Radiat Oncol Biol Phys 1993, 26:809–816.PubMedGoogle Scholar
  31. 31.
    Russell AH, Mesic JB, Scudder SA, et al.: Synchronous radiation and cytotoxic chemotherapy for locally advanced or recurrent squamous cancer of the vulva. Gynecol Oncol 1992, 47:14–20.PubMedCrossRefGoogle Scholar
  32. 32.
    Berek JS, Heaps JM, Fu YS, et al.: Concurrent cisplatin and 5-fluorouracil chemotherapy and radiation therapy for advanced-stage squamous carcinoma of the vulva. Gynecol Oncol 1991, 42:197–201.PubMedCrossRefGoogle Scholar
  33. 33.
    Thomas G, Dembo A, DePetrillo A, et al.: Concurrent radiation and chemotherapy in vulvar carcinoma. Gynecol Oncol 1989, 34:263–267.PubMedCrossRefGoogle Scholar
  34. 34.
    Moore DH, Thomas GM, Montana GS, et al.: Preoperative chemoradiation for advanced vulvar cancer: a phase II study of the Gynecologic Oncology Group. Int J Radiat Oncol Biol Phys 1998, 42:79–85. This paper describes the GOG study and focuses on the patients that had unresectable primary tumors. This paper reports one of the largest series of patients evaluated and treated according to a protocol.PubMedCrossRefGoogle Scholar
  35. 35.
    Montana GS, Thomas GM, Moore DH, et al.: Preoperative chemo-radiation for carcinoma of the vulva with N2/N3 nodes: a Gynecologic Oncology Group study. Int J Radiat Oncol Biol Phys 2000, 48:1007–1013. This article also describes the results of the GOG study, but it pertains to the patients with unresectable lymph nodes. The significance of this report lies in the fact that patients with inoperable nodes were rendered operable, resulting in some of the patients being cured of their disease.PubMedCrossRefGoogle Scholar
  36. 36.
    Montana GS: Carcinoma of the vulva. In Principles and Practice of Radiation Oncology. Edited by Perez CA, Brady LW, Halperin EC, Ullrich-Schmidt RK. Philadelphia: Lippincott Williams & Wilkins; 2003.Google Scholar

Copyright information

© Current Science Inc 2004

Authors and Affiliations

  • Gustavo S. Montana
    • 1
  1. 1.Department of Radiation OncologyDuke University Medical CenterDurhamUSA

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