title: Combined radiotherapy and chemotherapy in the management of local-regionally advanced vulvar cancer.
abstract: OBJECTIVE
  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
  From 1984 to 1991, 20 patients with locally extensive primary or recurrent carcinoma of the vulva were treated with initial combined radiotherapy and chemotherapy. Seven patients had Federation Internationale de Gynecologie et d'Obstretrique Stage III disease, 10 had Stage IV disease, and three were treated for recurrent disease. None of these patients were considered candidates for primary radical vulvectomy and groin node dissection. Median radiation doses to regions of microscopic disease 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 Cis-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 tumor relapse. Eight other patients had partial responses, with tumor bulk reduced by > 50%, while the remaining two patients had local-regionally progressive disease. Six of the patients with partial responses had residual tumor successfully resected, although four subsequently recurred. For the entire group of 20 patients, the actuarial 3- and 5-year local control rates were 48% each, and the corresponding disease-specific survival rates were 59% and 49%. There was a suggestion that better local control was obtained in patients who received gross tumor radiation doses > or = 50 Gy. Skin reaction was the major acute toxicity and responded well to conservative management. Long-term sequalae were limited to skin and subcutaneous atrophy.
  
  
  CONCLUSIONS
  These results indicate that initial combined radiotherapy and chemotherapy is effective in the management of advanced vulvar cancer.
authors.affiliation: Department of Radiation Oncology, University of Washington Medical Center, Seattle 98195.
authors.forename: W J
authors.initials: WJ
authors.lastname: Koh
authors.forename: H J
authors.initials: HJ
authors.lastname: Wallace
authors.forename: B E
authors.initials: BE
authors.lastname: Greer
authors.forename: J
authors.initials: J
authors.lastname: Cain
authors.forename: K J
authors.initials: KJ
authors.lastname: Stelzer
authors.forename: K J
authors.initials: KJ
authors.lastname: Russell
authors.forename: H K
authors.initials: HK
authors.lastname: Tamimi
authors.forename: D C
authors.initials: DC
authors.lastname: Figge
authors.forename: A H
authors.initials: AH
authors.lastname: Russell
authors.forename: T W
authors.initials: TW
authors.lastname: Griffin
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D002945:Cisplatin / Q000627:therapeutic use*; D003131:Combined Modality Therapy / Q000009:adverse effects; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use*; D012189:Retrospective Studies; D015996:Survival Rate; D014846:Vulvar Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*
chemical_list: D016685:Mitomycin; D002945:Cisplatin; D005472:Fluorouracil