Treatment Of Vaginal Ca


  • Surgical Excision
    • Shorten Vagina —> dysfunction
  • Radiotherapy
    • Entire vaginal mucosa should receive 50 to 60 Gy(multicentricity)
    • Boost tumour to 70-80 Gy
    • One or two implants, prescribed to the mucosal surface
    • Higher doses may cause significant vaginal fibrosis and stenosis.
  • Topical 5FU
    • 5% 5-FU b.i.d. x 5 d; Repeat in 12 wk
  • Laser Therapy

All have good outcome 10yr OS ~90%

Invasive Carcinoma


  • Primary treatment is RT
  • Good outcome reported with Sx
  • Better surgical candidate:
    • Stage I —> ~80%
    • surgical candidate:
      • Upper lesions
        • radical hysterectomy pelvic lymphadenectomy with upper vaginectomy
        • lower may need vulvovaginectomy and inguinal nodal dissection or even exentration
      • stage I and II(?)
      • May be appropriate for rare patients who present with primary disease-related fistulas
        • They require surgery for restoration of continence anyway
  • Always consider the chance of need for adj RT


Combination of multiple technique.

Generally, patients with early disease receive a higher proportion of their dose from brachy- therapy, whereas those with more advanced pelvic disease receive a greater component of their dose from EBRT.

Stage I

  • Intracavitary Brachytherapy-LDR
    • Entire length of vagina —> mucosal dose of 60 Gy to 0.5cm depth
    • Additional mucosal dose of 20 to 30 Gy is delivered to the area of tumor involvement
  • Role of Pelvic RT?
    • Not clear
    • General consensus that EBRT is advisable for those who have higher risk of LN mets:
      • Larger
      • More infiltrating
      • Poorly differentiated
      • WHole Pelvis —> 10 or 20 Gy
      • More parametrial dose should be delivered with a midline block 5 half-value layer (HVL) to a total of 45-50Gy

5-year survival for stage I treated with RT alone —> 70-95%

Stage II

  • Pelvis RT 45-50
  • If middle or lower third —> Inguinal LN need RT

Technique of RT

Organs at risk:

  • Rectum
  • Bladder
  • Small bowel
  • Vagina ( Sexual Dysfunction )
  • Bones