title: Squamous cell carcinoma of the vagina: natural history, treatment modalities and prognostic factors.
abstract: Squamous cell carcinoma of the vagina accounts for less than 2% of all gynecologic malignancies. Surgery has a role in selected cases only. The standard treatment is radiotherapy, external beam radiation and/or brachytherapy, depending on the extent, thickness, location and morphology of the lesion. The role of chemotherapy is still under evaluation. Radiotherapy obtained 5-year overall survival rates ranged from 35% to 78%, with severe late complication rates of 9.4-23.1%. Tumor stage is the strongest prognostic factor. Tumor size >4cm, tumor location outside the upper third of the vagina, and old age at presentation are additional predictors of poor survival in most papers, whereas the prognostic value of histological grade, prior hysterectomy, and hemoglobin levels is controversial. High-risk HPV DNA and low MIB-1 index are associated with better clinical outcome. Because of the rarity of this tumor, future multicenter studies would be strongly warranted.
authors.affiliation: Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Italy. Electronic address: a.gadducci@obgyn.med.unipi.it.
authors.forename: Angiolo
authors.initials: A
authors.lastname: Gadducci
authors.affiliation: Department of Oncology, Division of Radiation Oncology, University of Pisa, Italy.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Fabrini
authors.affiliation: Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Italy.
authors.forename: Nora
authors.initials: N
authors.lastname: Lanfredini
authors.affiliation: Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Sergiampietri
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D011379:Prognosis; D012307:Risk Factors; D016896:Treatment Outcome; D014625:Vaginal Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology / Q000628:therapy*
keywords: Biological prognostic variables; Brachytherapy; Clinico-pathological prognostic variables; Concurrent chemoradiation; External beam radiation; Human papilloma virus; Surgery; Vaginal carcinoma