TREATMENT OF ADVANCED-CARCINOMA OF THE VULVA WITH CHEMORADIOTHERAPY -CAN EXENTERATIVE SURGERY BE AVOIDED

Thirty-seven patients with advanced FIGO stage (17 stage III, 20 stage IV) carcinoma of the vulva whose extent of disease would have require d extenterative surgery were treated with chemoradiotherapy (CRT). Rad iotherapy was given as a split course (2500 cGy mid-plane dose in 10 d aily fractions, repeated 1 month later) to the first seven patients. S ubsequently radiotherapy was given as a continuous course (4500 cGy mi dplane dose in 20-25 daily fractions). Chemotherapy included mitomycin c as an intravenous bolus and 5 fluorouracil as a continuous intra-ve nous infusion over 4-5 days, with variations in timing and dose accord ing to the type of radiotherapy course. Fifteen (47%) complete and 11 (34%) partial responses were seen at 3 months after completion of trea tment. Of the 15 patients with complete response, 10 remained disease- free for a median of 24 months (range 6-36 months). The median sur-viv al for complete and partial responding patients was 15 and 11 months, respectively (range 2-37 months). Acute toxicity included moist perine al desquamation, diarrhea and myelosupression. One death secondary to neutropaenic sepsis occurred in the split course group. WHO grade 3 ra diation enteritis occurred in one patient (14%) in the split course an d two patients (6%) in the continuous CRT groups. Using CRT, very high response rates have been obtained with relatively low toxicity. There is a useful role for CRT in the treatment of patients with locally ad vanced recurrent disease although its place in the management of exten sive primary disease requires further evaluation.