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Vulva

  • Carlos A. Perez
  • Imran Zoberi
Chapter
Part of the Medical Radiology book series (MEDRAD)

Abstract

This chapter summarizes prognostic factors affecting therapeutic decisions, management guidelines and describes in detail techniques of irradiation for the treatment of patients with carcinoma of the vulva.

Keywords

Intensity Modulate Radiation Therapy Pelvic Lymph Node Inguinal Node Wide Local Excision Vulvar Cancer 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Ahmad M, Song H, Moran M et al (2004) IMRT of whole pelvis and inguinal nodes: evaluation of dose distributions produced by an inverse treatment planning system. Int J Radiat Oncol Bio Phys 60(Suppl):S484–S485Google Scholar
  2. Anderson ES, Sorenson IM (1988) Verrucous carcinoma of the female genital tract: report of a case and review of the literature. Gynaecol Oncol 30:427–434CrossRefGoogle Scholar
  3. Backstrom A, Edsmyr F, Wicklund H (1972) Radiotherapy of carcinoma of the vulva. Acta Obstet Gynaecol Scand 51:109–115CrossRefGoogle Scholar
  4. Balat O, Edwards CL, Delclos L (2000) Complications following combined surgery (radical vulvectomy versus wide local excision) and radiotherapy for the treatment of carcinoma of the vulva: report of 73 patients. Eur J Gynaecol Oncol 21:501–503PubMedGoogle Scholar
  5. Balat O, Edwards CL, Delclos L (2001) Advanced primary carcinoma of the Barthlin gland: report of patients. Eur J Gynaecol Oncol 22:46–49PubMedGoogle Scholar
  6. Baltzer JE, Kurzl RY, Lohe KJ et al (1986) Melanoma of the vulva. J Reprod Med 31:825–827PubMedGoogle Scholar
  7. Barnhill DR, Boling R, Nobles W et al (1988) Vulvar dermatofibrosarcoma protuberans. Gynaecol Oncol 30:149–152CrossRefGoogle Scholar
  8. Benda JA, Platz CE, Anderson B (1986) Malignant melanoma of the vulva: a clinical-pathologic review of 16 cases. Int J Gynaecol Pathol 5:202–216CrossRefGoogle Scholar
  9. Beriwal S, Heron DE, Kim H et al (2006) Intensity modulated radiotherapy for the treatment of vulvar carcinoma: a comparative dosimetric study with early clinical outcome. Int J Radiat Oncol Bio Phys 64:1395–1400CrossRefGoogle Scholar
  10. Berman ML, Soper JT, Creasman WT et al (1989) Conservative surgical management of superficially invasive stage I vulvar carcinoma. Gynaecol Oncol 35:352–357CrossRefGoogle Scholar
  11. Binder SW, Huang I, Fu YS et al (1990) Risk factors for the development of lymph node metastasis in vulvar squamous carcinoma. Gynaecol Oncol 37:9–16CrossRefGoogle Scholar
  12. Boronow RC (1973) Therapeutic alternative to primary exenteration for advanced vulvovaginal cancer. Gynaecol Oncol 1:233CrossRefGoogle Scholar
  13. Boronow RC (1982) Combined therapy as an alternative to exenteration for locally advanced vulvo-vaginal cancer: rationale and results. Cancer 49:1085–1091PubMedCrossRefGoogle Scholar
  14. Boronow RC, Hickman BT, Regan MT (1987) Combined therapy as an alternative to exenteration for locally advanced vulvovaginal cancer II. Results, complications, and dosimetric and surgical considerations. Am J Clin Oncol (CCT) 10:171–181CrossRefGoogle Scholar
  15. Boutselis JG (1972) Radical vulvectomy for invasive squamous cell carcinoma of the vulva. Obstet Gynaecol 39:827–836Google Scholar
  16. Brand E, Fu YS, Lagasse LD et al (1989) Vulvovaginal melanoma: report of seven cases and literature review. Gynaecol Oncol 33:54–60CrossRefGoogle Scholar
  17. Breen JL, Neubecker RD, Greenwald E (1975) Basal cell carcinomas of the vulva. Obstet Gynaecol 46:122–129Google Scholar
  18. Bryon SC, Dembo AJ, Colgan TJ et al (1991) Invasive squamous cell carcinoma of the vulva: defining low and high risk groups for recurrence. Int J Gynaecol Can 1:25–31CrossRefGoogle Scholar
  19. Burger MPM, Holleman H, Bouma J (1996) The side of groin node metastases in unilateral vulvar carcinoma. Int J Gynaecol Cancer 6:318–322CrossRefGoogle Scholar
  20. Burke TW, Stringer CA, Gershenson DM (1990) Radical wide excision and selective inguinal node dissection for squamous cell carcinoma of the vulva. Gynaecol Oncol 38:328–332CrossRefGoogle Scholar
  21. Burke TW, Levenback C, Coleman RC et al (1995) Surgical therapy of T1 and T2 vulvar carcinoma: further experience with radical wide excision and selective inguinal lymphadenectomy. Gynaecol Oncol 57:215–220CrossRefGoogle Scholar
  22. Burke TW, Eifel P, McGuire W (1996) Vulva. In: Hoskins WJ, Perez CA, Young RC (eds) Principles and practice of gynaecologic oncology, 2nd edn. Lippincott-Raven, PhiladelphiaGoogle Scholar
  23. Busch M, Wagener B, Schaffer M et al (2000) Long-term impact of postoperative radiotherapy in carcinoma of the vulva FIGO I/II. Int J Radiat Oncol Biol Phys 48:213–218PubMedCrossRefGoogle Scholar
  24. Calgar H, Hertzog AW, Hreschyshyn MM (1981) Topical 5-fluorouracil treatment of vaginal intraepithelial neoplasia. Obstet Gynaecol 5:580Google Scholar
  25. Cardosi RJ, Sprights A, Fiorica JW et al (2001) Bartholin’s gland carcinoma: a 15-year experience. 82:247–251Google Scholar
  26. Carlino G, Parisi S, Montemaggi P et al (1984) Interstitial radiotherapy with 192Ir in vulvar cancer. Eur J Gynaecol Oncol 3:183–185Google Scholar
  27. Chafe W, Richards A, Morgan L et al (1988) Unrecognized invasive carcinoma in vulvar intraepithelial neoplasia (VIN). Gynaecol Oncol 31:154–162CrossRefGoogle Scholar
  28. Chung AF, Woodruff JM, Lewis JL Jr (1975) Malignant melanoma of the vulva. Obstet Gynaecol 45:638–646CrossRefGoogle Scholar
  29. Cohn DE, Dehdashti F, Gibb RK et al (2002) Prospective evaluation of prositron emission tomography for the detection of groin node metastases from vulvar cancer. Gynaecol Oncol 85:179–184CrossRefGoogle Scholar
  30. Copeland LJ, Sneige N, Gershenson DM et al (1986) Bartholin gland carcinoma. Obstet Gynaecol 67:794–801CrossRefGoogle Scholar
  31. Creasman WT (1990) New gynaecologic cancer staging. Obstet Gynaecol 75:287–288Google Scholar
  32. Curry SL, Wharton JT, Rutledge F (1980) Positive lymph nodes in vulvar squamous carcinoma. Gynaecol Oncol 9:63–67CrossRefGoogle Scholar
  33. de Hullu JA, Oonk MH, van der Zee AG (2004) Modern management of vulvar cancer. Curr Opin Obstet Gynaecol 16:65–72CrossRefGoogle Scholar
  34. Dehner LP (1973) Metastatic and secondary tumors of the vulva. Obstet Gynaecol 52:47–57Google Scholar
  35. DiSaia PJ, Creasman WT, Rich WM (1979) An alternative approach to early cancer of the vulva. Am J Obstet Gynaecol 133:825–832Google Scholar
  36. Donaldson ES, Powell DE, Hanson MB et al (1981) Prognostic parameters in invasive vulvar cancer. Gynaecol Oncol 11:184–190CrossRefGoogle Scholar
  37. DuBeshter B, Lin J, Angel C et al (1993) Gynaecologic tumors. In: Rubin P (ed) Clinical oncology for physicians and medical students: a multidisciplinary approach, 7th edn. WB Saunders, PhiladelphiaGoogle Scholar
  38. Dusenbery KE, Carlson JW, LaPorte RM et al (1994) Radical vulvectomy with postoperative irradiation for vulvar cancer: therapeutic implications of a central block. Int J Radiat Oncol Biol Phys 29:989–998PubMedCrossRefGoogle Scholar
  39. Edge SB, Byrd DR, Compton CC et al (2010) AJCC Vancer Staging Handbook, 7th edn. Springer, New York, Dordrecht, Heidelberg, London, p 463Google Scholar
  40. Eifel PH, Morris M, Burke TW et al (1995) Prolonged continuous infusion cisplatin and 5-fluorouracil with radiation for locally advanced carcinoma of the vulva. Gynaecol Oncol 59:51–56CrossRefGoogle Scholar
  41. Farias-Eisner R, Cirisano FD, Grouse D et al (1994) Conservative and individualized surgery for early squamous carcinoma of the vulva: the treatment of choice for stage I and II (T1–2 N0–1M0) disease. Gynaecol Oncol 53:55–58CrossRefGoogle Scholar
  42. Figge DC, Tamimi HK, Greer BE (1985) Lymphatic spread in carcinoma of the vulva. Am J Obstet Gynaecol 152:387–394Google Scholar
  43. Fiorica JV, Cavanagh D, Marsden DE et al (1988) Carcinoma in situ of the vulva: 24 years’ experience in Southwest Florida. South Med J 81:589–593PubMedCrossRefGoogle Scholar
  44. Franklin EW (1972) Clinical staging of carcinoma of the vulva. Obstet Gynaecol 40:277Google Scholar
  45. Franklin EW, Rutledge FD (1971) Prognostic factors in epidermoid carcinoma of the vulva. Obstet Gynaecol 39:892–901Google Scholar
  46. Gitsch G, van Eijkeren M, Hacker NF (1995) Surgical therapy of vulvar cancer in pregnancy. Gynaecol Oncol 56:213–215CrossRefGoogle Scholar
  47. Gonzalez Bosquet J, Kinney WK, Russell AH et al (2003) Risk of occult inguinofemoral node metastases from squamous carcinoma of the vulva. Int J Radiat Oncol Bio Phys 57:419–424CrossRefGoogle Scholar
  48. Gosling JRG, Abell MR, Drolette BM et al (1961) Infiltrative squamous cell carcinoma of the vulva. Cancer 14:330–343PubMedCrossRefGoogle Scholar
  49. Grigsby PW, Roberts HL, Perez CA (1995) Femoral neck fracture following groin irradiation. Int J Radiat Oncol Biol Phys 32:63–67PubMedCrossRefGoogle Scholar
  50. Hacker NF, Leuchter RS, Berek JS et al (1981) Radical vulvectomy and bilateral inguinal lymphadenectomy through separate groin incisions. Obstet Gynaecol 58:574–579Google Scholar
  51. Hacker NF, Berek JS, Lagasse L et al (1983) Management of regional lymph nodes and their prognostic influence in vulvar cancer. Obstet Gynaecol 61:408–412Google Scholar
  52. Hacker NF, Berek JS, Juillard GJF et al (1984a) Preoperative radiation therapy for locally advanced vulvar cancer. Cancer 54:2056–2061PubMedCrossRefGoogle Scholar
  53. Hacker NF, Berek JS, Lagasse LD et al (1984b) Individualization of treatment for stage I squamous cell vulvar carcinoma. Obstet Gynaecol 63:155–162Google Scholar
  54. Han SC, Kim DH, Higgins SA et al (2000) Chemoradiation as primary or adjuvant treatment for locally advanced carcinoma of the vulva. Int J Radiat Oncol Biol Phys 47:1235–1244PubMedCrossRefGoogle Scholar
  55. Harper JL, Jenrette JM, Goddu SM et al (2004) Vulvar cancer in a patient with Fanconi’s anemia, treated with 3-D conformal radiotherapy. Am J Hematol 776:148–151CrossRefGoogle Scholar
  56. Hays DM, Shimada H, Raney RB et al (1988) Clinical staging and treatment results in rhabdomyosarcoma of the female genital tract among children and adolescents. Cancer 61:1893–1903PubMedCrossRefGoogle Scholar
  57. Heaps JM, Fu YS, Montz FJ et al (1990) Surgical-pathologic variables predictive of local recurrence in squamous cell carcinoma of the vulva. Gynaecol Oncol 38:309–314CrossRefGoogle Scholar
  58. Helgason NM, Hass AC, Latourette HB (1972) Radiation therapy in carcinoma of the vulva. Cancer 30:997–1000PubMedCrossRefGoogle Scholar
  59. Helwig EB, Graham JH (1963) Anogenital (extramammary) Paget’s disease. Cancer 16:387–403PubMedCrossRefGoogle Scholar
  60. Hoffman MS, Roberts WS, Ruffolo EH (1988) Basal cell carcinoma of the vulva with inguinal lymph node metastases. Gynaecol Oncol 29:113–119CrossRefGoogle Scholar
  61. Hoffman M, Greenberg S, Greenberg H et al (1990) Interstitial radiotherapy for the treatment of advanced or recurrent vulvar and distal vaginal malignancy. Am J Obstet Gynaecol 162:1278–1282Google Scholar
  62. Homesley HD, Bundy BN, Sedlis A et al (1986) Radiation therapy versus pelvic node resection for carcinoma of the vulva with positive groin nodes. Obstet Gynaecol 68:733–740Google Scholar
  63. Hoskins W, Perez CA (1989) Gynecologic tumors. In: De Vita VT, Hellman S, Rosenberg SA (eds) Chapter in Cancer: principles and practice of oncology, 3rd edn. JB Lippincott, PhiladelphiaGoogle Scholar
  64. Hruby G, MacLeod C, Firth I (2000) Radiation treatment in recurrent squamous cell cancer of vulva. Int J Radiat Oncol Bio Phys 46:1193–1197CrossRefGoogle Scholar
  65. Husseinzadeh N, Newman NJ, Wesseler TA (1989) Vulvar intraepithelial neoplasia: a clinicopathological study of carcinoma in situ of the vulva. Gynaecol Oncol 33:157–163CrossRefGoogle Scholar
  66. Iversen T (1982) Irradiation and bleomycin in the treatment of inoperable vulval carcinoma. Acta Obstet Gynaecol Scand 61:195–197CrossRefGoogle Scholar
  67. Iversen T, Aalders JG, Christensen A et al (1980) Squamous cell carcinoma of the vulva: a review of 424 patients, 1956–1974. Gynaecol Oncol 9:271–279CrossRefGoogle Scholar
  68. Jhingran A , Levanbak C, Katz A et al (2003) Radiation therapy for vulvar carcinoma: prediclors of vulvar recurrence. Int J Radiat Oncol Bio Phys S193 (Suppl 1) Abstr #115Google Scholar
  69. Kalnicki S, Zide A, Maleki N et al (1987) Transmission block to simplify combined pelvic and inguinal radiation therapy. Radiology 164:578–580PubMedGoogle Scholar
  70. Katz A, Eifel PJ, Jhingran A et al (2003) The role of radiation therapy in preventing regional recurrences of invasive squamous cell carcinoma of the vulva. Int J Radiat Oncol Biol Phys 57:409–418PubMedCrossRefGoogle Scholar
  71. Kaufman RH, Gardner HL (1965) Intraepithelial carcinoma of the vulva. Clin Obstet Gynaecol 8:1035–1050CrossRefGoogle Scholar
  72. Kelley JL III, Burke TW, Tornos C et al (1991) Minimally invasive vulvar carcinoma: an indication for conservative surgical therapy. Gynaecol Oncol 144:240–244Google Scholar
  73. King GC, Sonnik DA, Dalend AM et al (1993) Transmission block technique for the treatment of the pelvis and perineum including the inguinal lymph nodes: dosimetric considerations. Med Dosim 18:7–12PubMedGoogle Scholar
  74. Koh WJ, Chiu M, Stelzer KJ et al (1993a) Femoral vessel depth and the implications for groin node radiation. Int J Radiat Oncol Biol Phys 27(4):969–974PubMedCrossRefGoogle Scholar
  75. Koh WJ, Wallace JH III, Greer BE et al (1993b) Combined radiotherapy and chemotherapy in the management of local-regionally advanced vulvar cancer. Int J Radiat Oncol Biol Phys 26:809–816PubMedCrossRefGoogle Scholar
  76. Krupp PJ, Bohm JW (1978) Lymph gland metastases in invasive squamous cell cancer of the vulva. Am J Obstet Gynaecol 130:943–952Google Scholar
  77. Krupp PJ, Lee FYL, Bohm JW et al (1975) Prognostic parameters and clinical staging criteria in epidermoid carcinoma of the vulva. Obstet Gynaecol 46:84–88CrossRefGoogle Scholar
  78. Kuipers T (1975) Carcinoma of the vulva. Radiol Clin 44:475–483Google Scholar
  79. Kurzl R, Messerer D (1989) Prognostic factors in squamous cell carcinoma of the vulva: a multivariate analysis. Gynaecol Oncol 32:143–150CrossRefGoogle Scholar
  80. Lasser A, Cornorg IJT, Morris JM (1974) Adenoid squamous carcinoma of the vulva. Cancer 33:224–227PubMedCrossRefGoogle Scholar
  81. Lelle RJ, Davis KP, Roberts JA (1994) Adenoid cystic carcinoma of the Bartholin’s gland: the University of Michigan experience. Int J Gynaecol Cancer 4:145–149CrossRefGoogle Scholar
  82. Leuchter RS, Hacker NF, Vopet RL et al (1982) Primary carcinoma of the Bartholin gland: a report of 14 cases and review of the literature. Obstet Gynaecol 60:361–368Google Scholar
  83. Lucas WE, Bernischke K, Lebherz TB (1974) Verrucous carcinoma of the female genital tract. Am J Obstet Gynaecol 119:435–440Google Scholar
  84. Malfetano JH, Piver S, Tsukada Y et al (1985) Univariate and multivariate analyses of 5-year survival, recurrence, and inguinal node metastases in stage I and II vulvar carcinoma. J Surg Oncol 30:124–131PubMedCrossRefGoogle Scholar
  85. McCall AR, Olson MC, Potkul RK (1995) The variation of inguinal lymph node depth in adult women and its importance in planning elective irradiation for vulvar cancer. Cancer 75(9):2286–2288PubMedCrossRefGoogle Scholar
  86. Miyazawa K, Nori D, Hilaris BS et al (1983) Role of radiation therapy in the treatment of advanced vulvar carcinoma. J Reprod Med 28:539–541PubMedGoogle Scholar
  87. Montana GS, Thomas GM, Moore DH et al (2000) Preoperative chemo-radiation for carcinoma of the vulva with N2/N3 nodes: a gynaecologic oncology group study. Int J Radiat Oncol Biol Phys 48:1007–1013PubMedCrossRefGoogle Scholar
  88. Moore DH, Koh W-J, McGuire WP, Wilkinson EJ (2009) Vulva. In: Barakat RR, Markman M, Randall M (eds) Principle and practice of gynaecologic oncology, 5th edn. Wolters Kluwer, Lippincott Williams & Wilkins, Philadelphia p 553 (Chapter 20)Google Scholar
  89. Morris JM (1977) A formula for selective lymphadenectomy. Obstet Gynaecol 50:152–158Google Scholar
  90. Nobler MP (1972) Efficacy of a perineal teletherapy portal in the management of vulvar and vaginal cancer. Radiology 103:393–397PubMedGoogle Scholar
  91. Nori D, Cain JM, Hilaris BS et al (1983) Metronidazole as a radiosensitizer and high-dose radiation in advanced vulvovaginal malignancies: a pilot study. Gynaecol Oncol 16:117–128CrossRefGoogle Scholar
  92. Origoni M, Sideri M, Garsia S et al (1992) Prognostic value of pathological patterns of lymph node positivity in squamous cell carcinoma of the vulva stage III and IVA FIGO. Gynaecol Oncol 45:313–316CrossRefGoogle Scholar
  93. Pao WM, Perez CA, Kuske RR et al (1988) Radiation therapy and conservation surgery for primary and recurrent carcinoma of the vulva: report of 40 patients and a review of the literature. Int J Radiat Oncol Biol Phys 14:1123–1132PubMedCrossRefGoogle Scholar
  94. Parker RT, Duncan I, Rampone J et al (1975) Operative management of early invasive epidermoid carcinoma of the vulva. Am J Obstet Gynaecol 123:349–355Google Scholar
  95. Perez CA, Grigsby PW, Galakatos A et al (1993) Radiation therapy in management of carcinoma of the vulva with emphasis on conservation therapy. Cancer 71(11):3707–3716PubMedCrossRefGoogle Scholar
  96. Perez CA, Grigsby PW, Chao KSC et al (1997) Vulva. In: Perez CA, Brady LW (eds) Principles and practice of radiation oncology, 3rd edn. Lippincott-Raven, Philadelphia, pp 1915–1942Google Scholar
  97. Perez CA, Grigsby PW, Chao KSC et al (1998) Irradiation in carcinoma of the vulva: factors affecting outcome. Int I Radiat Oncol Bio Phys 42:335–344CrossRefGoogle Scholar
  98. Perrone T, Twiggs LB, Adcock LL et al (1987) Vulvar basal cell carcinoma: an infrequently metastasizing neoplasm. Int J Gynaecol Pathol 6:152–165CrossRefGoogle Scholar
  99. Petereit DG, Mehta MP, Buchler DA et al (1993) Inguinofemoral radiation of N0, N1 vulvar cancer may be equivalent to lymphadenectomy if proper radiation technique is used. Int J Radiat Oncol Biol Phys 27:963–967PubMedCrossRefGoogle Scholar
  100. Plentl AA, Friedman EA (1971) Lymphatic system of the female genitalia. WB Saunders, PhiladelphiaGoogle Scholar
  101. Pohar S, Hoffstetter S, Peiffert D et al (1995) Effectiveness of brachytherapy in treating carcinoma of the vulva. Int J Radiat Oncol Biol Phys 32:1455–1460PubMedCrossRefGoogle Scholar
  102. Rosén C, Malmström H (1997) Invasive cancer of the vulva. Gynaecol Oncol 656:213–217CrossRefGoogle Scholar
  103. Rosenberg P, Simonses E, Risberg D (1989) Adenoid cystic carcinoma of Bartholin’s gland: a report of five new cases treated with surgery and radiotherapy. Gynaecol Oncol 34:145–147CrossRefGoogle Scholar
  104. Rowley KC, Gallion HH, Donaldson SE et al (1988) Prognostic factors in early vulvar cancer. Gynaecol Oncol 31:43–49CrossRefGoogle Scholar
  105. Russell AH, Mesic JB, Scudder SA et al (1992) Synchronous radiation and cytotoxic chemotherapy for locally advanced or recurrent squamous cancer of the vulva. Gynaecol Oncol 47:14–20CrossRefGoogle Scholar
  106. Rutledge F, Smith JP, Franklin EW (1970) Carcinoma of the vulva. Am J Obstet Gynaecol 106:1117–1130Google Scholar
  107. Rutledge FN, Mitchell MF, Munsell MF et al (1991) Prognostic indicators for invasive carcinoma of the vulva. Gynaecol Oncol 42:239–244CrossRefGoogle Scholar
  108. Scheistroen M, Trope C (1993) Combined bleomycin and irradiation in preoperative treatment of advanced squamous cell carcinoma of the vulva. Acta Oncol 32:657–661PubMedCrossRefGoogle Scholar
  109. Schulz U, Callies R, Kruger KG (1980) Effizienz der postoperativen elektronentherapie des lokalisierten vulvakarzinoms. Strahlentherapie 156:326–330PubMedGoogle Scholar
  110. Sedlis A, Homesley H, Bundy BN et al (1987) Positive groin lymph nodes in superficial squamous cell vulvar cancer. Am J Obstet Gynaecol 156:1159–1164Google Scholar
  111. Shepherd JH (1989) Revised FIGO staging for gynaecological cancer. Br J Obstet Gynaecol 96:889–892PubMedCrossRefGoogle Scholar
  112. Shimm DS, Fuller AF, Orlow EL et al (1986) Prognostic variables in the treatment of squamous cell carcinoma of the vulva. Gynaecol Oncol 24:343–358CrossRefGoogle Scholar
  113. Sillman FH, Sedlis A, Boyce JG (1985) A review of lower genital intraepithelial neoplasia and the use of topical 5-fluorouracil. Obstet Gynaecol Surg 40:190–220CrossRefGoogle Scholar
  114. Stehman FB, Bundy BN, Dvoretsky PM et al (1992a) Early stage I carcinoma of the vulva treated with ipsilateral superficial inguinal lymphadenectomy and modified radical hemivulvectomy: a prospective study of the gynaecologic oncology group. Obstet Gynaecol 79:490–497Google Scholar
  115. Stehman FB, Bundy BN, Thomas C et al (1992b) Groin dissection versus groin radiation in carcinoma of the vulva: a Gynaecologic Oncology Group study. Int J Radiat Oncol Biol Phys 24(2):389–396PubMedCrossRefGoogle Scholar
  116. Stern BD, Kaplan L (1969) Multicentric foci of carcinoma arising in structures of cloacal origin. Am J Obstet Gynaecol 104:255–266Google Scholar
  117. Tavassoli FA, Norris HJ (1979) Smooth muscle tumors of the vulva. Obstet Gynaecol 53:213–217Google Scholar
  118. Thomas G, Dembo A, DePetrillo A et al (1989) Concurrent radiation and chemotherapy in vulvar carcinoma. Gynaecol Oncol 34:263–267CrossRefGoogle Scholar
  119. Ulbright TM, Brokaw SA, Stehman FB et al (1983) Epithelioid sarcoma of the vulva. Cancer 52:1462–1469PubMedCrossRefGoogle Scholar
  120. van der Velden K, Ansink A (2001) Primary groin irradiation vs primary groin surgery for early vulvar cancer. Cochrane Database Syst Rev 4:CD002224Google Scholar
  121. van der Velden J, van Lindert AC, Lammes FB et al (1995) Extracapsular growth of lymph node metastases in squamous cell carcinoma of the vulva. Cancer 75:2885–2890PubMedCrossRefGoogle Scholar
  122. Wahlen SA, Slater JD, Wagmer RJ et al (1995) Concurrent radiation therapy and chemotherapy in the treatment of primary squamous cell carcinoma of the vulva. Cancer 75:2289–2294PubMedCrossRefGoogle Scholar
  123. Wang CJ, Chin YY, Leung SW et al (1996) Topographic distribution of inguinal lymph nodes metastasis: significance in determination of treatment margin for elective inguinal lymph nodes irradiation of low pelvic tumors. Int J Radiat Oncol Biol Phys 35:133–136PubMedCrossRefGoogle Scholar
  124. Weiner SA, Lee JKT, Kao MS et al (1986) The role of lymphangiography in vulvar carcinoma. Am J Obstet Gynaecol 5:1073–1075Google Scholar
  125. Wharton JT, Gallagher S, Rutledge FN (1974) Microinvasive carcinoma of the vulva. Am J Obstet Gynaecol 118:159–162Google Scholar
  126. Wo JY, Tanaka C, Shultz D et al (2008) Predictors of Vulvar Recurrence: the effect of margin status. Int J Radiat Oncol Bio Phys S20 72 (Suppl 1) Abstr # 42Google Scholar
  127. Woolcott RJ, Henry RJW, Houghton CRS (1988) Malignant melanoma of the vulva. J Reprod Med 33:699–702PubMedGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  1. 1.Department of Radiation OncologyWashington University Medical CenterSt. LouisUSA
  2. 2.Department of Radiation OncologyWashington University School of MedicineSt. LouisUSA

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