Radiotherapy for advanced vulva cancer

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Mansoor Raza Mirza Dept. of Oncology Odense
University Hospital Odense, Denmark
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Stage III Tumor with adjacent spread to
urethra, vagina or anus or with unilateral
lymphnode metastases Stage IVa Tumor invades
upper urethra, bladder mucosa, rectal mucosa or
pelvic bone or bilateral node metastases Stage
IVb Distant metastases
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• Disease extended beyond the boundaries of
  surgical feasibility
• Radiotherapy was administered using suboptimal
  dose /fractionation schedules as well as
  primitive techniques

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• n 37
• Median radiation dose 48 Gy
• No residual disease in 42 patients at the time
  of surgery
• 5 yr. survival 75,6

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Randomized Controlled Trial - GOG Radiotherapy
vs Surgery T1-3 N0-1 M0 n58 (27 in Rt
arm) Radiotherapy 50 Gy at 3cm Results Groin
recurrence 5/27 (18.5) OS 60 vs 86
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Case control study Radiotherapy vs wait and
see T1 N0-1 M0 n135 (65 received
Rt) Radiotherapy 45Gy at 5cm telecobalt Results
Groin recurrence 3/65 (4.6) OS 93.7 vs 91.4
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Observational T1-3 N0-3 M0 n6818 LERt 14
Rt 1918 RVRt 24 PVRt 11 Radiotherapy
50-70Gy at 4cm Results Groin recurrence 10 OS
?
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Stehman FB et al. Manavi M et al. Perez CA et
al. Conclusions Primary radiotherapy to the
groin results in less morbidity but also in a
higher number of groin recurrences compared with
surgery. Surgery is still to be considered the
cornerstone of therapy for the groin nodes.
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Retrospective analysis of one centre
data 1980-1998 n227 (stage III/VI 119
Stage I/II 67) LND 119 LNDRt 57 Rt
51 Radiotherapy narrow inguinal
fields 45/50Gy or 60Gy Surgery superficial
LND Results 5 yrs groin recurrence 16 vs 13
vs 16 OS ?
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Preoperative chemo-radiation (GOG) T3-4 or
N2-3 n7346 Radiotherapy Split course 47,6Gy
in 6-6.5 weeks Chemotherapy Cis5-Fu Response
evaluation 4-8 wks after end of
treatment Results Complete clinical remission
46.5 and 43
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Primary radical chemoradiotherapy
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Radical chemoradiotherapy for relapse
Meta-analysis Van Doorn et al. The Cochrane
Library, issue 4, 2002, Oxford
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• Subclinical target volume (T N site)
• 50 - 56 Gy (lt2 Gy/fraction)
• Gross tumor volume
• Min. 60 Gy (2 Gy/fraction)

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Concomitant weekly cisplatin 40 mg/m2
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12 weeks after end of treatment
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Dept. of Oncology Odense University
Hospital Odense, Denmark