238 Vaginal Carcinoma and Vulvar Carcinoma
50. Vaginal Carcinoma and Vulvar Carcinoma
50.1 General considerations
50.1.1. Vaginal Carcinoma
|
FIGO-classification of vaginal carcinoma |
|
Stage T N M Tumor characteristics |
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0 Tis N0 M0 Carcinoma in situ |
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I T1 N0 M0 Carcinoma is limited to vaginal wall |
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II T2 N0 M0 Carcinoma has involved subvaginal tissue, but has not extended to pelvic wall |
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III T1,2 N1 M0 Carcinoma has extended to pelvic wall T3 N0,1 M0 |
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IV T4 any N M0 Carcinoma has extended beyond the true Pelvis,or has clinically involved the mucosa of the bladder or rectum |
Varying degrees of surgical excision can be performed for preinvasive disease
stages, while radiation therapy is the cornerstone for invasive squamous
neoplasms. For patients with disease which has spread to distant organs(stage
IVB) systemic chemotherapy can be taken into consideration.
Literature:
PIURA et al,Eur .J.Gynaecol.Oncol.19(1998):60-63(report of cases and review of the literature) .
50.1.2 ; Vulvar Carcinoma
|
FIGO/UICC-classification of vulvar carcinoma |
|
FUGO UICC Tumor characteristics |
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0 Tis N0 M0 Carcinoma in situ |
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I T1 N0 M0 Tumor confined to the vulva and/or per- ineum; < 2 cm in greatest dimension |
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II T2 N0 M0 Tumor confined to the vulva and/or per- ineum, > 2 cm in greatest dimension |
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III T3 N0 M0 Tumor of any size with adjacent spread to T1-3 N1 M0 the lower urethra and/or the vagina or to the anus and/or unilateral regional lymph node metastasis |
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IVA T1-3 N2 M0 Tumor invades any of the following: rectal T4 any N M0 mucosa,upper urethra, bladder mucosa, pelvic bone, and/or bilateral regional nodes |
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IVB any T any N M1 Any distant metastasis, incl.pelvic lymph nodes |
Treatment is based on surgical excision.Radiation therapy is occasionally used
to treat medically inoperable disease. Radiation/chemotherapy combinations can
be administered for advanced- stage disease in an effort to reduce the radicality
of subsequent surgical resection. In case of lymph node metastases
radiotherapy and in case of distant metastases chemotherapy are possible options.
Vaginal Carcinoma and Vulva Carcinoma 239
Literature: for review e.g.
AKL et al,Int.J. Radiat.Oncol.Biol.Phys.48(2000):415-420
(chemoradiotherapy)
GHURANI and PENALVER , Am.J.Obstet.Gynecol.185(2001):294-299
&#GRENDYS and FIORICA, Curr.Opin.Obstet.Gynecol.12(2000):15-20
HOMESLEY,Cancer 76(Suppl)(1995):159-170
MARSDEN and HACKER,Surg.Clin.North Am.81(2001):799-813
50.2 Vaginal carcinoma
50.2.1. Cisplatin
|
Cisplatin 50mg/mē i.v.(1h inf) d1 |
To be repeated every 3-4 weeks (4-6 cycles in responders)
Literature:
THIGPEN et al,Gynecol.Oncol.23 (1986): 101-104
50.2.2. BVMP
|
Bleomycin 15mg/mē i.v.(bolus) d1-3 |
|
Vincristine 1.4mg/mē i.v.(bolus) d3 (max 2 mg) |
|
Mitomycin 10mg/mē i.v.(bolus) d3 |
|
Cisplatin 60mg/mē i.v.(1 h inf) d3 |
To be repeated every 4 weeks(4 cycles in responders)
Literature:
BELINSON et al, Gynecol.Oncol.20(1985):387-393
50.3 Vulvar carcinoma
50.3.1 9; Bleomycin
|
Bleomyocin 15mg/mē i.m. or i.v.(bolus) 2 x weekly |
In responders up to a maximal total dose of 300 mg
Literature:
TROPE et al, Cancer Treat . Rep. 64 (1980) : 639 - 642
50.3.2 Radiochemotherapy
|
Cisplatin 4mg/mē i.v.(cont inf) d1-4 |
|
5-Fluorouracil 250mg/mē i.v.(cont inf) d1-4 |
To be repeated weekly (4X) .Plus simultaneous radiation:40-50 Gy(2
Gy perfraction) .
Literature:
EIFFEL et al,Gynecol.Oncol.59(1995):51-56
or
|
Cisplatin 100mg/mē i.v. d1 |
|
5-Fluorouracil 1000mg/mē i.v.(cont inf) d2-5 |
To be repeated beginning on day 28.Total irradiation dose: 44-54Gy.
Literature:
McINTOSH , in Current Therapy in Cancer(Foley, Vose,
Armitage,eds)(1999): 167-173.