Recurrent Vulvar Cancer
Treatment and outcome depend on the site and extent of recurrence. Radical excision of localized recurrence may be considered if technically feasible. Palliative radiation therapy is used for some patients. Radiation therapy with or without chemotherapy may be associated with substantial disease-free periods in some patients with a small local recurrence.[3-5] When local recurrence occurs more than 2 years after primary treatment, a combination of radiation therapy and surgery may result in a 5-year survival rate of greater than 50%.[6,7]
There is no standard treatment approach in the management of metastatic vulvar cancer. There is no standard chemotherapy, and reports describing the use of this modality are anecdotal. However, by largely extrapolating from regimens used for anal or cervical cancer, chemotherapy has been used, but with no clear evidence of improvement in survival or palliation. Regimens have included various combinations of 5-fluorouracil, cisplatin, mitomycin-C, or bleomycin.[8,9] Given the advanced age and comorbidity of many patients with advanced or recurrent vulvar cancer, patient tolerance is a major consideration in the use of these agents. Physicians should offer eligible patients participation in clinical trials.
Information about ongoing clinical trials is available from the NCI Web site.
Standard treatment options:
- Wide local excision with or without radiation in those patients with local recurrence.
- Radical vulvectomy and pelvic exenteration in patients with local recurrence.
- Synchronous radiation and cytotoxic chemotherapy with or without surgery.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent vulvar cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.References
- Piura B, Masotina A, Murdoch J, et al.: Recurrent squamous cell carcinoma of the vulva: a study of 73 cases. Gynecol Oncol 48 (2): 189-95, 1993. [PUBMED Abstract]
- Hopkins MP, Reid GC, Morley GW: The surgical management of recurrent squamous cell carcinoma of the vulva. Obstet Gynecol 75 (6): 1001-5, 1990. [PUBMED Abstract]
- Miyazawa K, Nori D, Hilaris BS, et al.: Role of radiation therapy in the treatment of advanced vulvar carcinoma. J Reprod Med 28 (8): 539-41, 1983. [PUBMED Abstract]
- Russell AH, Mesic JB, Scudder SA, et al.: Synchronous radiation and cytotoxic chemotherapy for locally advanced or recurrent squamous cancer of the vulva. Gynecol Oncol 47 (1): 14-20, 1992. [PUBMED Abstract]
- Thomas G, Dembo A, DePetrillo A, et al.: Concurrent radiation and chemotherapy in vulvar carcinoma. Gynecol Oncol 34 (3): 263-7, 1989. [PUBMED Abstract]
- Podratz KC, Symmonds RE, Taylor WF, et al.: Carcinoma of the vulva: analysis of treatment and survival. Obstet Gynecol 61 (1): 63-74, 1983. [PUBMED Abstract]
- Shimm DS, Fuller AF, Orlow EL, et al.: Prognostic variables in the treatment of squamous cell carcinoma of the vulva. Gynecol Oncol 24 (3): 343-58, 1986. [PUBMED Abstract]
- Eifel PJ, Berek JS, Markman MA: Cancer of the cervix, vagina, and vulva. In: DeVita VT Jr, Lawrence TS, Rosenberg SA: Cancer: Principles and Practice of Oncology. 9th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2011, pp 1311-44.
- van Doorn HC, Ansink A, Verhaar-Langereis M, et al.: Neoadjuvant chemoradiation for advanced primary vulvar cancer. Cochrane Database Syst Rev 3: CD003752, 2006. [PUBMED Abstract]