Management
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.
