title: "Unresectable" vulval cancers: is neoadjuvant chemotherapy the way forward?
abstract: Squamous cell carcinoma of the vulva is an uncommon gynaecological malignancy, but the incidence is increasing. A significant proportion of patients present with locally advanced disease, and management can prove challenging because of the size and/or location of the tumour. Surgery forms the mainstay of treatment, but the role of neoadjuvant therapy in minimizing morbidity is under investigation. Although chemotherapy alone has been largely neglected in favour of chemoradiotherapy, concerns about the toxicity of trimodality therapy and suboptimal results, particularly in node-positive patients, have led to renewed interest in neoadjuvant chemotherapy (NACT). A review of the available literature illustrates that NACT can produce dramatic responses, but operability rates and overall survival differ widely. The effect is dependent on as yet unidentified factors, although we speculate that age and tumour biology are important. Further work is required to delineate the optimal NACT regimen and the patient population(s) most likely to benefit from this practice.
authors.affiliation: Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Great Western Road, Glasgow, G12 0YN, UK, kgraham7@nhs.net.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Graham
authors.forename: Kevin
authors.initials: K
authors.lastname: Burton
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery; D017024:Chemotherapy, Adjuvant / Q000379:methods; D005260:Female; D006801:Humans; D020360:Neoadjuvant Therapy / Q000379:methods* / Q000639:trends; D014846:Vulvar Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery