Treatment

Surgery is first choice in the treatment of vulvar cancer. In the early part of this century, treatment mainly consisted of local excision and 5-year survival was a mere 20%. Overall survival figures rose to more than 60% when Taussig and Way introduced radical vulvectomy with en bloc bilateral inguinofemoral and pelvic lymphadenectomy to replace simple local excision [11,12]. Due to this dramatic improvement of prognosis, this radical surgical approach became the standard treatment for almost all patients with vulvar cancer. Over the past 15 years, however, the surgery has become more conservative. Significant advances have been made by the elimination of routine pelvic lymphadenectomy, introduction of radical local excision instead of radical vulvectomy, and unilateral or bilateral inguinofemoral lymphadenectomy via separate incisions in selected cases. In general, it appears that individualization of treatment results in high efficacy with less morbidity [3].

Postoperative adjuvant radiotherapy to the inguinofemoral and pelvic lymph nodes is indicated when more than one involved inguinofemoral lymph node is found or when tumor growth extends beyond the capsule of a lymph node [13,14]. Radiotherapy can also be part of alternative primary therapy in patients with midline tumors in order to preserve important anatomical structures like the clitoris, the urethra, and the anal sphincter [15,16]. In advanced disease, radiotherapy (in combination with chemotherapy and/or surgery) may be used as primary treatment [3]. The indications for chemotherapy are limited. A number of compounds are available as radiosensitizers and can be used in conjunction with radiotherapy, especially in advanced vulvar cancer [3].

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