Treatment Of Vaginal Ca
Table of Contents
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VAIN
- 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
Surgery
- 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
- Upper lesions
- Always consider the chance of need for adj RT
Radiation
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
page revision: 16, last edited: 25 Jul 2012 22:37