Stage I Vaginal Cancer
Squamous Cell Carcinoma
Adenocarcinoma
Current Clinical Trials
Squamous Cell Carcinoma
The treatments listed below produce equivalent cure rates. The
selection of treatment depends on patient factors and local expertise.
Standard treatment options for superficial lesions less than 0.5 cm thick:
- Intracavitary radiation therapy. In most instances, 60 Gy to 70 Gy
prescribed to 0.5 cm is delivered to the tumor for 5 to 7 days
(external-beam radiation therapy [EBRT] is required for bulky lesions).[1] For lesions of
the lower third of the vagina, elective radiation therapy of 45 Gy to 50 Gy
is given to pelvic and/or inguinal lymph nodes.[1]
- Surgery. Wide local excision or total vaginectomy with vaginal
reconstruction, especially in lesions of the upper vagina. In cases with
close or positive surgical margins, adjuvant radiation therapy should be
considered.[2]
Standard treatment options for lesions greater than 0.5 cm thick:
- Surgery. In lesions of the upper third of the vagina, radical
vaginectomy and pelvic lymphadenectomy should be performed. Construction of a
neovagina may be performed if feasible and if desired by the patient.[2,3]
In lesions of the lower third, inguinal lymphadenectomy should be
performed. In cases with close or positive surgical margins, adjuvant
radiation therapy should be considered.[2]
- Radiation therapy. Combination of interstitial (single-plane implant) and
intracavitary therapy to a dose of at least 75 Gy to the primary tumor.
In addition to brachytherapy, EBRT is advocated for
poorly differentiated or infiltrating tumors that may have a higher
probability of lymph node metastasis.[1,4] For lesions of the lower third of
the vagina, elective radiation therapy of 45 Gy to 50 Gy is given to the
pelvic and/or inguinal lymph nodes.[1]
Adenocarcinoma
Standard treatment options:
- Surgery. Because the tumor spreads subepithelially, total radical
vaginectomy and hysterectomy with lymph node dissection are indicated. The
deep pelvic nodes are dissected if the lesion invades the upper vagina, and the
inguinal nodes are removed if the lesion originates in the lower vagina.
Construction of a neovagina may be performed if feasible and if desired by the
patient.[2] In cases with close or positive surgical margins, adjuvant
radiation therapy should be considered.[2,3]
- Intracavitary and interstitial radiation as previously described for
squamous cell cancer.[1] For lesions of the lower third of the vagina,
elective radiation therapy of 45 Gy to 50 Gy is given to the pelvic and/or inguinal
lymph nodes.[1]
- Combined local therapy in selected cases, which may include wide local
excision, lymph node sampling, and interstitial therapy.[5]
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage I vaginal 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
-
Perez CA, Camel HM, Galakatos AE, et al.: Definitive irradiation in carcinoma of the vagina: long-term evaluation of results. Int J Radiat Oncol Biol Phys 15 (6): 1283-90, 1988.
[PUBMED Abstract]
-
Stock RG, Chen AS, Seski J: A 30-year experience in the management of primary carcinoma of the vagina: analysis of prognostic factors and treatment modalities. Gynecol Oncol 56 (1): 45-52, 1995.
[PUBMED Abstract]
-
Rubin SC, Young J, Mikuta JJ: Squamous carcinoma of the vagina: treatment, complications, and long-term follow-up. Gynecol Oncol 20 (3): 346-53, 1985.
[PUBMED Abstract]
-
Andersen ES: Primary carcinoma of the vagina: a study of 29 cases. Gynecol Oncol 33 (3): 317-20, 1989.
[PUBMED Abstract]
-
Senekjian EK, Frey KW, Anderson D, et al.: Local therapy in stage I clear cell adenocarcinoma of the vagina. Cancer 60 (6): 1319-24, 1987.
[PUBMED Abstract]
Back to Top
< Previous Section | Next Section > |