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Radiation for Cancer of the Vulva

Traditionally radiation was not used for cancer of the vulva because this area of the body is so sensitive and does not tolerate radiation well , it was assumed that it was not possible to give enough radiation to be of benefit. Currently radiation is used in combination with more limited surgery (as noted below in the review by Perez and review article here.

For more advanced cases radiation is combined with chemotherapy. (See the discussion of the GOG101 trial and the GOG 205 here)

Other areas where radiation is used:
- combined with chemotherapy for advanced case
- summary table of chemo-radiation
- radiation used to treat the lymph nodes

See typical radiation field from GOG protocol (IJROBP 2000; 48(4):1007) and RTOG port 1 , port 2, more port #3, port #4.

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Int J Radiat Oncol Biol Phys 1998 Sep 1;42(2):335-44

Irradiation in carcinoma of the vulva: factors affecting outcome.

Perez Mallinckrodt Institute .This report reviews the increasing role of radiation therapy in the management of patients with histologically confirmed vulvar carcinoma, In patients treated with biopsy/local excision and irradiation, local tumor control was 92% to 100% in Stages T1-3N0, 40% in similar stages with N1-3, and 27% in recurrent tumors. In patients treated with partial/radical vulvectomy and irradiation, primary tumor control was 90% in patients with T1-3 tumors and any nodal stage, 33% in patients with any T stage and N3 lymph nodes, and 66% with recurrent tumors. The actuarial 5-year disease-free survival rates were 87% for T1N0, 62% for T2-3N0, 30% for T1-3N1 disease, and 11 % for patients with recurrent tumors; there were no long-term survivors with T4 or N2-3 tumors. In patients with T1-2 tumors treated with biopsy/wide tumor excision and irradiation with doses under 50 Gy, local tumor control was 75% (3 of 4), in contrast to 100% (13 of 13) with 50.1 to 65 Gy. In patients with T3-4 tumors treated with local wide excision and irradiation, tumor control was 0% with doses below 50 Gy (3 patients) and 63% (7 of 11) with 50.1 to 65 Gy. In patients with T1-2 tumors treated with partial/radical vulvectomy and irradiation, local tumor control was 83% (14 of 17), regardless of dose level, and in T3-4 tumors, it was 62% (5 of 8) with 50 to 60 Gy and 80% (8 of 10) with doses higher than 60 Gy. The differences are not statistically significant. There was no significant dose response for tumor control in the inguinal-femoral lymph nodes; doses of 50 Gy were adequate for elective treatment of nonpalpable lymph nodes, and 60 to 70 Gy controlled tumor growth in 75% to 80% of patients with N2-3 nodes when administered postoperatively after partial or radical lymph node dissection. CONCLUSIONS: Irradiation is playing a greater role in the management of patients with carcinoma of the vulva; combined with wide local tumor excision or used alone in T1-2 tumors, it is an alternative treatment to radical vulvectomy, with significantly less morbidity. Postradical vulvectomy irradiation in locally advanced tumors improves tumor control at the primary site and the regional lymphatics in comparison with reports of surgery alone.