CONCURRENT RADIATION-THERAPY AND CHEMOTHERAPY IN THE TREATMENT OF PRIMARY SQUAMOUS-CELL CARCINOMA OF THE VULVA

Background. Interest in combined modality treatment and in quality of life issues may affect the choice of radical vulvectomy as the treatme nt 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 ou tcomes of 19 patients with this disease treated with combination thera py were reviewed. Methods. Nineteen patients were treated between Sept ember 1987 and October 1992. Fifteen patients had American Joint Commi ttee on Cancer Stage III disease; 4 had Stage II. All had clinically n egative inguinal lymph nodes with the exception of two patients who ha d positive ipsilateral inguinal nodes that were removed before treatme nt. The patients received 45-50 Gy to the pelvis and inguinal nodes wi th concurrent chemotherapy that consisted of 5-fluorouracil given as a 96-hour continuous infusion (1000 mg/m(2)/d) during weeks 1 and 5 of radiation. A single dose of mitomycin-C (10 mg/m(2)) during the first day of chemotherapy has been used since November 1991. Ten patients we re boosted with implants or electrons and 6 others underwent local exc ision. Results. The median follow-up was 34 months. Responses were det ermined clinically I month after completion of the radiation and chemo therapy. Clinically, complete responses were obtained in 10 patients ( 53%), partial responses in 7 (37%), and no response in 1; 1 patient pr ogressed during treatment. The combined modality therapy (radiation/ch emotherapy/with or without wide local excision) resulted in a local co ntrol rate of 74% (14/19). All five treatment failures occurred within 6 months of treatment. Four of these patients were rendered disease f ree by radical vulvectomy and/or exenteration, for an overall local co ntrol rate of 95% (18/19). Conclusion. Concurrent radiation therapy an d chemotherapy with local excision performed as needed, appears to be a reasonable alternative to radical vulvectomy in patients with primar y squamous cell carcinoma of the vulva. Radical surgery remains a viab le option for patients in whom primary therapy has failed.