Standard treatment in vulvar cancer is surgery or, for most patients with stage III or IV disease, surgery supplemented by external-beam radiation therapy.[1-3] Newer strategies integrate possible therapeutic advantages of surgery, radiation therapy, and chemotherapy and tailor the treatment to the extent of clinical and pathologic disease. Because of the psychosexual consequences and significant morbidity associated with standard radical vulvectomy, there is a definite trend toward vulvar conservation and individualized management of patients with early vulvar cancer. Since invasive and preinvasive neoplasms of the vulva may be HPV-induced and the carcinogenic effect may be widespread in the vulvar epithelium, close follow-up of patients is mandatory so that early detection of recurrent or second tumors is possible. Because there are few patients with far advanced disease, and they are often elderly, minimal data has been generated on responses, and therefore there is no standard chemotherapy for patients with this stage of disease. Physicians should consider including patients with stage III or IV disease in clinical trials evaluating the following adjuncts to standard surgical procedures: radiation sensitizers, chemotherapy in phase II trials, and combined modality studies. The Gynecologic Oncology Group is investigating the feasibility of preoperative chemotherapy plus radiation therapy as a neoadjuvant to surgery for advanced vulvar cancer.

References

1. Hacker NF, Van der Velden J: Conservative management of early vulvar cancer. Cancer 71 (4 Suppl): 1673-7, 1993.  [PUBMED Abstract]
   
   
2. Thomas GM, Dembo AJ, Bryson SC, et al.: Changing concepts in the management of vulvar cancer. Gynecol Oncol 42 (1): 9-21, 1991.  [PUBMED Abstract]
   
   
3. Homesley HD, Bundy BN, Sedlis A, et al.: Radiation therapy versus pelvic node resection for carcinoma of the vulva with positive groin nodes. Obstet Gynecol 68 (6): 733-40, 1986.  [PUBMED Abstract]
   
   

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