Changing concepts in the management of vulvar cancer.

Vulvar carcinoma varies widely in its clinical presentations and prognosis. The reviewed literature outlines the achievements of conventional surgery, radiation, or chemoradiation therapy in its management. Currently therapeutic concepts are evolving. New treatment strategies replacing the uniform use of radical vulvectomy and bilateral groin dissection are proposed. These strategies are tailored to the clinical and pathological disease extent and location and integrate the possible therapeutic advantages of both surgery and chemoradiation. The testing and use of the proposed multimodality therapy protocols require the expertise of gynecologic, radiation, and medical oncologists. This approach should lead to improved anatomic and functional preservation in early disease and improved locoregional in advanced disease.