Radiotherapy in vulvar cancer treatment

Czech version

Authors: I. Sirák; M. Hodek; J. Petera; Z. Zoul; M. Vošmik ; J. Jansa
Authors‘ workplace: Klinika onkologie a radioterapie FN, Hradec Králové, přednosta prof. MUDr. J. Petera, Ph. D.
Published in: Ceska Gynekol 2013; 78(3): 257-262

Overview

Objective:
To provide an actual review of radiotherapy in the treatment of vulvar carcinoma.

Design:
A review article.

Setting:
Department of Oncology and Radiotherapy, University Hospital in Hradec Králové.

Methods:
A review article evaluating the application of ionizing radiation in the treatment of early and advanced vulvar carcinoma, based on the most significant previously published studies.

Conclusion:
Postoperative groin irradiation in patients with positive groin lymph-nodes improves local control, time to progression, and overall survival; especially in ≥ 2 positive nodes and in N2/3 initial findings. In case of positive inguinal nodes, radiotherapy of both groins and at least lower pelvic iliac node-chains should follow. Adjuvant irradiation of the primary remains controversial, except for positive resection margins where radiotherapy improves overall survival. Concurrent chemoradiotherapy seems to be appropriate primary treatment of advanced vulvar carcinomas, in attempt to avoid mutilating intervention or exenteration. Chemoradiation should be followed by subsequent surgery, including potential groin dissection in case of lymph-node involvement. Definitive chemoradiotherapy is of limited evidence, and radical dose escalation to the gross tumor is essential for its implementation. Modern radiotherapy techniques, especially with intensity modulation, are convenient for dose escalation.

Keywords:
vulvar carcinoma – radiotherapy – chemoradiation – IMRT – brachytherapy

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