Chemotherapy and radiation therapy in the treatment of squamous cell carcinoma of the vulva: Are two therapies better than one?

As gynecologic surgeons garnered a better understanding of various clinical-pathological prognostic factors, there evolved a number of modifications in the surgical approach allowing for more individualized therapy with less morbidity, while still retaining the curative potential of the radical vulvectomy operation. The incorporation of radiation therapy and eventually chemotherapy in the primary treatment of vulva cancer also represents a slow evolution in clinical management. The addition of chemotherapy concurrent to radiation therapy for the treatment of vulvar carcinoma was heavily influenced by advances in the treatment of cervical cancer, and squamous cell carcinoma of the anal canal. On the basis of many good phase II studies but no randomized controlled trials in the disease, chemoradiation therapy is now inherent to the clinical management of vulvar carcinoma. The rarity of vulva cancer precludes prospective randomized clinical trials in the absence of international collaboration. Nonetheless, patients with locally advanced vulva cancer have derived considerable benefit from chemoradiation studies in other related tumor sites, and will continue to do so in the future.