Vagina Cancer. Treatments.
Treatments
Most vaginal carcinomas are best treated with radiation therapy. Patients with occult or smaller than 1-cm, stage I, superficial lesions could be considered for radical surgery. Select patients with a lesion in the upper third of the vagina may be candidates for radical hysterectomy, vaginec-tomy, and bilateral pelvic lymph node dissection. Patients with positive nodes should receive external beam irradiation through appropriately designed ports, particularly if more than three nodes are involved. Patients with mid-vaginal, early-stage cancers are probably best treated with radiation therapy. For nonsurgical candidates, when cancers are superficial, the usual treatment is a combination of interstitial implants and a vaginal cylinder. Doses range from 6,000 to 7,000 cGy to the tumor area. Patients with thick, infiltrating, stage I disease are often treated with additional external beam irradiation.
For other patients with locally advanced squamous cell cancers, individualized radiation therapy is administered. Generally used is 4,000 cGy to the whole pelvis with a 5,000- to 6,000-cGy total parametrial dose, along with a combination of interstitial and intracavitary insertions to deliver a total dose of 7,500-8,000 cGy to the vaginal lesion and 6,500 cGy to parametrial and paravaginal extensions. Use of radiation sensitizers, such as 5-fluorouracil plus cisplatin or mitomycin C, has been reported in recent series with little improvement in survival noted. Vaginal stenosis, vaginal necrosis, and proctitis are common complications. The rarely occurring fistulas to adjacent organs are usually seen in patients in whom a combination of surgery and irradiation has been tried. Ultraradical surgery is usually reserved for patients with local central recurrence.
Survival for patients with stage I vaginal cancer has been reported to range from 72% to 90%, and survival for stage II is around 55%. Approximately 45% of patients with stage III cancer will be 5-year survivors. Patients with stage IVA cancer have a 10-20% survival rate. Relatively improved survival is noted in patients younger than 60 years of age, patients with grade I tumors, and patients with nonbulky disease. Chemotherapy for distant recurrences has been largely ineffective, although cisplatin has been used.