Data compiled from Pride et al., 1979 (233); Houghton and Iversen, 1982 (229); Benedet et al., 1983 (205); Rubin et al., 1985 (207); Kucera et al., 1985 (228); Eddy et al., 1991 (232); Kirkbride et al., 1995 (234); Perez et al., 1999 (235); Tewari et al., 2001 (236); Otton et al., 2004 (237); Frank et al., 2005 (238); Hellman et al., 2006 (204); Tran et al., 2007 (239).
is used, high-and low-dose rate techniques were described. If the lesion is more than 0.5 cm thick, interstitial radiation techniques can improve the dose distribution to the primary tumor. Surgical exploration or laparoscopy at the time of insertion of Syed interstitial implants defines more precisely the placement of the needles and ensures that needles do not pass into adherent loops of bowel. Extended-field radiation may be used for vaginal cancer in a manner similar to its use for cervical carcinoma, although there is no experience reported with the use of this technique in the treatment of vaginal cancer. Likewise, there is little reported experience with combination chemoradiation treatment (231). Although there will never be enough patients for a proper randomized control trial, concurrent use of 5-FU and cisplatin was highly successful in anal and cervical cancer and thus should be considered for treatment of vaginal cancer.
Sequelae The proximity of the rectum, bladder, and urethra leads to a major complication rate of 10% to 15% for both surgery and radiation treatment. For large tumors, the risk of bladder or bowel fistula is significant. Radiation cystitis and proctitis are common, as are rectal strictures or ulcerations. Radiation necrosis of the vagina occasionally occurs, requiring debridement, and often leads to fistula formation. Vaginal fibrosis, stenosis, and stricture are common after radiation therapy. Use of vaginal dilators and resumption of regular sexual relations should be encouraged, along with the use of topical estrogen to maintain adequate vaginal function.
Survival The overall 5-year survival rate for patients with vaginal cancer is 52% (Table 36.7). This reﬂects the difficulties of treatment and the fact the disease presents at late stage. For patients with stage I disease, the 5-year survival rate is 74%. Most recurrences are in the pelvis, either from enlarged regional nodes or from large central tumors. Radiation techniques, including interstitial implants with Syed applicator and combination chemoradiation, are the mainstay of therapy. Careful evaluation of patients who receive radiation therapy to detect central recurrence may allow some patients to be saved by pelvic exenteration. Because of the rarity of vaginal cancer, these patients should be treated in a center that is familiar with the complexity of treatment and modalities of therapy.
1. Siegel R, Ward E, Brawley O, et al. Cancer statistics, 2011. CA Cancer J Clin 2011;61:212–236. http://cacancerjournal.org 2.
Womack C, Warren AY. Achievable laboratory standards: a review of cytology of 99 women with cervical cancer. Cytopathology 1998; 9:171.
3.
Pettersson F. Annual report on the results of treatment in gynecological cancer. Radiumhemmet, Stockholm, Sweden: International Federation of Gynecology and Obstetrics (FIGO), 1994:132–168.[MB6] 4.