VULVAR CARCINOMA

Purpose: Controversies exist regarding the use of radiation therapy in the treatment of vulvar carcinoma. A retrospective review was perform ed to evaluate our institution's experience with surgery and radiation for this disease. Methods and Materials: The medical records of 47 pa tients treated for squamous cell carcinoma of the vulva at our institu tion (1974-1992) were reviewed for TNM stage (AJCC criteria), treatmen t modality, and associated Li-year local control and survival based on Kaplan-Meier analysis. Results: Twenty-eight patients (60%) presented with Stage I and II disease and their 5-year survival was 69%. Stage III patients accounted for 12 (25%) of the patients and their 5-year s urvival was 73%. Seven patients presented with Stage IV disease and fi ve died within 13 months of diagnosis after predominantly palliative t herapy, The 40 patients with Stages I, II, and III disease were treate d aggressively and were further evaluated for treatment-modality-assoc iated survival and local control. Radiation therapy was used as primar y treatment in nine patients, of whom seven were treated with radiatio n alone and two were treated postoperatively after wide excision, Surg ery alone was performed in 31 patients consisting of either radical vu lvectomy (20 patients) or wide excision (11 patients), When comparing outcomes of radical vulvectomy vs, radiation therapy, we noted that th e 5-year actuarial survivals were comparable (74% for either modality) , despite the presence of more favorable prognostic factors in the gro up treated with radical vulvectomy, Patients treated with wide excisio n alone had a trend for a poorer 5-year actuarial survival (51%) and l ocal control (50%). Conclusions: Radical vulvectomy offers good locore gional control and survival, This retrospective review further support s the use of radiation therapy with conservative surgery as an alterna tive treatment option for patients with vulvar carcinoma treated with curative intent, In contrast, the use of wide excision alone should be performed with caution due to a higher Locoregional failure rate, The role of appropriately prescribed radiation therapy should be further investigated in prospective clinical trials.