Can radiotherapy be a treatment option for elderly women with invasive vulvar carcinoma without radical surgery?

Purpose of the investigation: To evaluate the impact of radiotherapy after limited surgery in vulvar carcinoma.

Methods: Between March 1980 and January 2000, 22 patients older than 60 years and suffering from invasive vulvar carcinoma were treated with limited surgery and radiotherapy at Gülhane Military Medicine Academy. These are the subjects of this review.

Results: The median age of the patients was 67 (range 60 to 78 years). Median follow-up was 35 months (range 12 to 60 months). Local recurrence rate was 18%. Median time to local failure was 12 months (range 8 to 14 months). Two patients with local failure also developed lung metastases. Five-year survival rate was 60% and cause-specific survival rate was 69%. No treatment delay or death related to treatment was observed.

Conclusions: Radiotherapy and conservative surgery can be an alternative to radical surgery with less morbidity in elderly patients.

Vulvar; Carcinoma; Radiotherapy; Surgery

[1] Friedrich E. G., Wilkinson E. J., Fu Y. S.: "Carcinoma in situ of vulva: A continuing challenge". Am. J. Obstet. Gynecol., 1980, 136, 830.

[2] Silverberg E., Boring C. C., Squires T. S.: "Cancer Statistics 1990". Cancer, 1990, 40, 9.

[3] National Institute of Statistics: "Women Statistics". 1999, die. gov. tr.

[4] Cavanagh D., Fiorica J. V., Hoffman M. S., Roberts W. S., Bryson S. C. P., LaPolla J. P., et al.: "Invasive carcinoma of the vulva: Changing trends in surgical management". Am. J. Obstet. Gynecol., 1990, 163, 1005.

[5] Homesley H. D., Bundy B. N., Sedlis A., Yordan E., Berek J., Jahsan A., et al.: "Assessment of current International Federation of Gynecology and Obstetrics staging of vulvar carcinoma relative to prognostic factors for survival (A Gynecologic Oncology Group Study)". Am. J. Obstet. Gynecol., 1991, 75, 997.

[6] Iversen T., Aalders J. G., Chiristensen A., Kolstad P.: "Squamous cell carcinoma of the vulva: A review of 424 patients, 1956-1974". Gynecol. Oneal., 1980, 9, 271.

[7] Kucera H., Weghaupt K.: "The electrosurgical operation of vulvar carcinoma with postoperative radiation of inguinal lymph nodes". Gynecol. Oneal., 1988, 29, 158.

[8] Morley G. W.: "Infiltrative carcinoma of the vulva: Results of surgical treatment". Am. J. Obstet. Gynecol., 1976, 124, 874.

[9] Podratz K. C., Symmonds R. E., Taylor W. F., Williams T. J.: "Carcinoma of the vulva: Analysis of treatment and survival". Obstet. Gynecol., 1983, 61, 63.

[10] Behars 0. H., Henson D. E., Hutter R. V. P., Kennedy B. J.: "Manual for Staging of Cancer". 4" edition, Philadelphia, JB Lippincott, 1992, 177.

[11] Perez C. A., Brady L. W.: "Overview. in Principles and Practice of Radiation Oncology". Eds. Perez C. A., Bradey L. W.; Philadelphia, J. B. Lippincott Co, 2nd Edition,1992, I.

[12] Stehman F. B., Bundy B. N., Dvoretsky P. M., Creasman W. T.: "Early stage I carcinoma of the vulva treated with ipsilateral superficial inguinal lymphadenectomy and modified radical hemivulvectomy: A prospective study of the Gynecologic Oncology Group". Obstet. Gynecol., 1992, 79, 490.

[13] Perez C. A., Grigsby P. W., Chao K. S. C., Galakatos A., Garipagaoglu M., Mutch D.: "Irradiation in carcinoma of the vulva: Factors affecting outcome". Int. J. Radiat. Oneal. Biol. Phys., 1998, 42, 335.

[14] Heaps J. M.,F u Y. S.,M ontz F. J.,H acker N. F.,B erek J. S.: "Surgical-pathological variables predictive of local recurrence in squamous carcinoma of the vulva". Gynecol. Oneal., 1990, 38, 309.

[15] Homesly H. D., Bundy B. N., Sedlis A., Yordan E., Berek J. S., Jahsan A. et al.: “Prognostic factors for groin node metastasis in squamous cell carcinoma of the vulva". Gynecol. Oncol., 1993, 49, 279.

[16] Kurz! R., Messerer D.: "Prognostic factors in squamous cell carcinoma of the vulva: A multivariate analysis". Gynecol. Oncol., 1989, 32, 143.

[17] Busch M., Wagener B., Schaffer M., Diihmke E.: "Long-term impact of postoperative radiotherapy in carcinoma of the vulva FIGO I/II. Int. J. Radiat". Oncol. Biol. Phys., 2000, 48, 213.

[18] Faul C. M., Mirmow D., Huang Q., Gerszten K., Day R., Jones M. S.: "Adjuvant radiation for vulvar carcinoma: Improved local control". Int. J. Radiat. Oncol. Biol. Phys., 1994, 29, 989.

[19] Frischbier H. J., Thomsen K.: "Treatment of cancer with highenergy electrons". Am. J. Obstet. Gynecol., 1971, 111, 431.

[20] Ellis F.:" Cancer of the vulva treated by radiation. An analysis of 127 cases". Brit. J. Radiol., 1949, 22, 513.

[21] Stehman F. B., Bundy B. N., Thomas G., Varia M., Okagaki T., Roberts J. et al.: "Groin dissection versus groin radiation in carcinoma of the vulva: A Gynecologic Oncology Group study". Int. J. Radiat. Oncol. Biol. Phys., 1992, 24, 389.

[22] Koh W. J., Chiu M., Stelzer K. J., Greer B. E., Mastras D., Comsia N. et al.: "Femoral vessel depth and the implications for groin node radiation". Int. J. Radiat. Oncol. Biol. Phys., 1993, 27, 969.

[23] McCall A. R., Olson M. C., Potkul R. K.: "The variation of inguinal lymph node depth in adult women and its importance in planning elective irradiation for vulvar cancer". Cancer, 1995, 75, 2286.

[24] Petereit D. G., Mehta M. P., Buchler D. A., Kinsella T. J.: "Inguinofemoral radiation of NO, NI vulvar cancer may be equivalent to lympadenectomy if proper radiation technique is used". Int. J. Radiat. Oncol. Biol. Phys.,1 993,2 7, 963.

[25] Homesly H. D., Bundy B. N., Sedlis A., Adcock L.: "Radiation therapy versus pelvic node resection for carcinoma of the vulva with positive groin nodes". Obstet. Gynecol., 1986, 68, 733.

[26] Schulz U., Callies R., Kriiger G. K.: "Effizienz der postoperativen elektronentherapie des lokalisierten vulvakarzinoms". Strahlentherapie, 1980, 156, 326.

[27] Pao W. M., Perez C. A., Kuske R. R., Sommers G. M., Camel H. M., Galakatos A. E.: "Radiation therapy and conservation surgery for primary and recurrent carcinoma of the vulva: report of 40 patients and review of the literature". Int. J. Radiat. Oncol. Biol. Phys., 1988, 14, 1123.

[28] Lee W. R., McCollough W. M., Mendenhall W. M., Marcus R. B., Parsons J. T., Million R. R.: "Elective inguinal lymph node irradiation for pelvic carcinomas: The University of Florida experience". Cancer, 1993, 72, 2058.