Conservative surgery plus adjuvant therapy for vulvovaginal rhabdomyosarcoma, diethylstilbestrol clear cell adenocarcinoma of the vagina, and unilateral germ cell tumors of the ovary.
Significant progress has been made in the 1980s in early-stage vulvovaginal rhabdomyosarcoma, diethylstilbestrol (DES) clear cell adenocarcinoma of the vagina, and unilateral germ cell tumors of the ovary. In an early state of vulvovaginal rhabdomyosarcoma, systemic vincristine, dactinomycin, and cyclophosphamide (VAC) chemotherapy followed by local excision or local radiation results in a high cure rate with retention of future fertility. Similarly, early-stage DES-related adenocarcinoma of the vagina treated by wide local excision and localized vaginal radiation also results in retention of fertility and a high cure rate. Finally, significant progress has been made in unilateral germ cell tumors of the ovary in which surgical treatment by unilateral salpingo-oophorectomy followed by cisplatin, etoposide, and bleomycin results in not only high cure rates and retention of fertility but will probably be standard therapy for all germ cell tumors of the ovary, including dysgerminoma, a disease most frequently treated in the past by radiation therapy with loss of subsequent fertility.
Hicks
M L
ML
Department of Gynecologic Oncology, Roswell Park Cancer Institute, Buffalo, New York.
Piver
M S
MS
D000230:Adenocarcinoma / Q000188:drug therapy / Q000601:surgery*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D002648:Child; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D003609:Dactinomycin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000601:surgery*; D012208:Rhabdomyosarcoma / Q000188:drug therapy / Q000601:surgery*; D014625:Vaginal Neoplasms / Q000188:drug therapy / Q000601:surgery*; D014750:Vincristine / Q000008:administration & dosage; D014846:Vulvar Neoplasms / Q000188:drug therapy / Q000601:surgery*
D003609:Dactinomycin; D014750:Vincristine; D003520:Cyclophosphamide