As always, management is stage dependent.

Early Stage

Locoregionally Advanced Disease (FIGO/TNM stage III, IVA)

These patients have a poor prognosis with 5 year survival under 50%. Management is complicated by:

  • The high morbidity of surgery for patients with large tumours involving the vagina and adjacent structures
  • The high morbidity of large radiotherapy doses delivered to adjoining structures
  • The increased morbidity caused by addition of chemotherapy to radiotherapy for both early and late toxicities

In general:

  • Surgery is usually contraindicated due to inoperability
  • Brachytherapy may be unable to give sufficient dose to the tumour once the size of the mass is over 4 cm. If brachytherapy is not possible then an external radiotherapy boost to 66-70 Gy should be considered
    • These doses will likely far exceed any rationale rectal constraints and the patient must be aware of the consequences
  • The addition of chemotherapy, similar to vulval and cervical squamous cell carcinomas, should be considered
    • The potential improvement in radiotherapy effectiveness must be countered by the potential for early toxicity causing delay in treatment time
    • Cisplatin is a good option for this

Metastatic Disease

Always associated with a poor prognosis. Systemic therapy, usually cisplatin based, may have some effect in fortunate patients.