Vulvar cancer medical therapy
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Radiation therapy and chemotherapy are usually not a primary choice of therapy but may be used in selected cases of advanced vulvar cancer. medical therapy
Stage 0 Vulvar Cancer
- CO2 laser surgery and vaporization. A disadvantage of vaporization is that it does not provide tissue for histologic examination to confirm complete removal of the lesion and the absence of invasive disease.
- Ultrasonic surgical aspiration (USA).
- Topical imiquimod for patients wishing to avoid surgery.
Stage I Vulvar Cancer
- Radical radiation therapy for patients unable to tolerate surgery or deemed unsuitable for surgery because of site or extent of disease.
Stage II Vulvar Cancer
- For those few patients unable to tolerate radical surgery or deemed unsuitable for surgery because of site or extent of disease, radical radiation therapy may be associated with favorable survival.
Stage III Vulvar Cancer
- Radical vulvectomy with inguinal and femoral node dissection followed by radiation therapy in patients with large primary lesions and narrow margins. Localized adjuvant radiation therapy consisting of 45 Gy to 50 Gy may also be indicated when there is capillary-lymphatic space invasion and a thickness of greater than 5 mm, particularly if the nodes are involved.[1] Radiation therapy to the pelvis and groin is usually given if two or more groin nodes are involved.
- Preoperative neoadjuvant radiation therapy or chemoradiation may be used to improve operability and even decrease the extent of surgery required.
- For the few patients unable to tolerate radical surgery or deemed unsuitable for surgery because of site or extent of disease, radical radiation therapy may be associated with long-term survival. Some physicians prefer to add concurrent 5-FU or 5-FU and cisplatin.