Chemoradiation in advanced vulval carcinoma

Introduction: 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 GSH9s experience of the use of chemoradiation as primary therapy for women with advanced vulval carcinoma. Methods: Data from patients9 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.