COMBINED RADIOTHERAPY AND CHEMOTHERAPY IN THE MANAGEMENT OF LOCAL-REGIONALLY ADVANCED VULVAR CANCER

Purpose: To determine, in a retrospective single institutional study, the role of concurrent radiotherapy and chemotherapy in the treatment of local-regionally advanced vulvar cancer. Methods and Materials: Fro m 1984 to 1991, 20 patients with locally extensive primary or recurren t carcinoma of the vulva were treated with initial combined radiothera py and chemotherapy. Seven patients bad Federation Internationale de G ynecologie et d'Obstretrique Stage III disease, 10 bad Stage IV diseas e, and three were treated for recurrent disease. None of these patient s were considered candidates for primary radical vulvectomy and groin node dissection. Median radiation doses to regions of microscopic dise ase and gross tumor were 40 Gy (range 30-54 Gy) and 54 Gy (34-70.4 Gy) , respectively. All patients received 2 or 3 cycles of 5-Fluorouracil concurrently with radiotherapy. In addition, five patients received Ci s-platinum, and one Mitomycin-C. Median at-risk follow-up interval was 37 months. Results: Ten patients had complete resolution of tumor to initial chemoradiotherapy, and eight of these have remained free of tu mor relapse. Eight other patients bad partial responses, with tumor bu lk reduced by > 50%, while the remaining two patients had local-region ally progressive disease. Six of the patients with partial responses h ad residual tumor successfully resected, although four subsequently re curred. For the entire group of 20 patients, the actuarial 3- and 5-ye ar local control rates were 48% each, and the corresponding disease-sp ecific survival rates were 59% and 49%. There was a suggestion that be tter local control was obtained in patients who received gross tumor r adiation doses greater-than-or-equal-to 50 Gy. Skin reaction was the m ajor acute toxicity and responded well to conservative management. Lon g-term sequalae were limited to skin and subcutaneous atrophy. Conclus ion: These results indicate that initial combined radiotherapy and che motherapy is effective in the management of advanced vulvar cancer.