Daya Nand Sharma1. 1. Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India. sharmadn@hotmail.com
Abstract
PURPOSE OF REVIEW: Vulvar cancer is a relatively rare gynecological malignancy afflicting elderly women. Although radiation therapy plays an important role, due to limited literature, treatment guidelines are less clearly defined. This article reviews the recent literature to discuss the current role of radiation therapy in the management of vulvar cancer. RECENT FINDINGS: There is a continuing scarcity of prospective and randomized controlled trials due to rarity of vulvar cancer. Most studies in the recent literature are largely retrospective in nature. However, it is evident from the available literature that combined chemoradiotherapy is slowly evolving as a new option in the management of locally advanced vulvar cancer (LAVC) reducing surgery-related morbidity. Various trials have tested the feasibility of concurrent chemoradiotherapy (CCRT) using different chemotherapeutic agents like cisplatin, 5-fluorouracil, mitomycin-C and have shown encouraging results. SUMMARY: For early-stage vulvar cancer, radiation therapy continues to play an adjuvant role. For LAVC, CCRT has emerged as a new feasible option both as preoperative and definitive treatment. Future CCRT trials should incorporate newer radiation therapy techniques like intensity-modulated radiation therapy to further reduce the radiation-related morbidity thus enhancing the tolerance of CCRT.
PURPOSE OF REVIEW: Vulvar cancer is a relatively rare gynecological malignancy afflicting elderly women. Although radiation therapy plays an important role, due to limited literature, treatment guidelines are less clearly defined. This article reviews the recent literature to discuss the current role of radiation therapy in the management of vulvar cancer. RECENT FINDINGS: There is a continuing scarcity of prospective and randomized controlled trials due to rarity of vulvar cancer. Most studies in the recent literature are largely retrospective in nature. However, it is evident from the available literature that combined chemoradiotherapy is slowly evolving as a new option in the management of locally advanced vulvar cancer (LAVC) reducing surgery-related morbidity. Various trials have tested the feasibility of concurrent chemoradiotherapy (CCRT) using different chemotherapeutic agents like cisplatin, 5-fluorouracil, mitomycin-C and have shown encouraging results. SUMMARY: For early-stage vulvar cancer, radiation therapy continues to play an adjuvant role. For LAVC, CCRT has emerged as a new feasible option both as preoperative and definitive treatment. Future CCRT trials should incorporate newer radiation therapy techniques like intensity-modulated radiation therapy to further reduce the radiation-related morbidity thus enhancing the tolerance of CCRT.