Chemoradiation in advanced vulval carcinoma.
BACKGROUND
Vulval carcinoma is uncommon, affecting approximately 2 per 100,000 women annually. The treatment of choice is radical vulvectomy and inguinal lymph node dissection. Advanced vulval carcinomas involve midline structures (such as clitoris, urethra, or anus) and/or adjacent pelvic organs or bone, and adequate excision may require urinary diversion, colostomy, or pelvic exenteration. Less morbid and less mutilating therapeutic alternatives have been investigated, particularly chemoradiation, which has shown success in the management of anal carcinomas. Chemoradiation has been used, instead of primary radical surgery, to treat advanced vulval carcinomas at Groote Schuur Hospital (GSH) since 1982. This is a retrospective study of the GSH's experience of the use of chemoradiation as primary therapy for women with advanced vulval carcinoma.


METHODS
Data from patients' medical records were transcribed onto a standardized pro forma, computerized, and analyzed.


RESULTS
Between 1982 and 2001, 50 women with advanced vulval carcinomas were treated with chemoradiation at GSH. Fourteen women (28%) who had a complete response to chemoradiation had significantly improved survival compared with 29 (58%) who had a partial response (P = 0.000218). Partial responders who had surgery had significantly better survival than those who did not (P = 0.0064). Other prognostic factors for survival were performance status and tumor stage.


CONCLUSIONS
Less than a third of the women treated with primary chemoradiation had a complete response. Survival was improved in women who responded partially but had residual disease surgically excised. Performance status, age, and tumor stage were also associated with survival.
Rogers
Linda J
LJ
Department of Gynaecological Oncology, Groote Schuur Hospital (GSH), University of Cape Town, Cape Town, South Africa. L.Rogers@uct.ac.za
Howard
Bruce
B
Van Wijk
Leon
L
Wei
Wenbin
W
Dehaeck
Katrien
K
Soeters
Robbert
R
Denny
Lynette A
LA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D009367:Neoplasm Staging; D012189:Retrospective Studies; D016896:Treatment Outcome; D014846:Vulvar Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*
D016685:Mitomycin; D005472:Fluorouracil