COMBINED PREOPERATIVE CHEMORADIOTHERAPY FOLLOWED BY RADICAL SURGERY IN LOCALLY ADVANCED VULVAR CARCINOMA - A PILOT-STUDY

BACKGROUND, Although for decades exenterative surgery has represented the standard treatment for patients with locally advanced vulvar cance r, combined approaches, including preoperative radiation with or witho ut chemotherapy, are now considered the treatment of choice. We report the results of a pilot study on concurrent chemoradiotherapy followed by radical surgery for patients with locally advanced squamous cell c arcinoma of the vulva. METHODS, Thirty-one patients with squamous cell carcinoma of the vulva were treated with two courses of combination c hemotherapy mitomycin C, 15 mg/m(2) intravenously (i.v.) on Day 1, and 5-fluorouracil, 750 mg/m(2) i.v., in continuous 24-hour infusion on D ays 1 to 5. Inguinal and pelvic lymph node chains and the vulva were i rradiated (starting on the same day as the chemotherapy) up to a total dose of 36 Gy. After a 2-week interval, a second course of chemoradio therapy was given (18 Gy on the vulvar region only). After 2 weeks, pa tients underwent radical surgery. RESULTS, An objective response was o bserved in 22 of 24 primary cases (91.6%) and in 7 of 7 recurrent case s. All but two unresponsive patients underwent radical surgery. The po stoperative morbidity rate was 65% (19 of 29 patients), and the mortal ity rate was 13.8% (4 of 29 patients). Five of nine patients (55%) wit h biopsy proven inguinal lymph node metastases showed no residual lymp h node disease in the surgical specimen. The recurrence rate was 31.8% and the median follow up time was 34 months. CONCLUSIONS. Chemoradiot herapy seems to be effective for squamous cell carcinoma of the vulva. If treatment-related morbidity could be decreased, such a combined ap proach might offer new perspectives for a conservative treatment of lo cally advanced vulvar cancer. (C) 1996 American Cancer Society.