Long-term results of radiotherapy alone for carcinoma of the vulva

From 1953 to 1978, definitive radiotherapy for carcinoma of the vulva without surgery was used as a standard therapy at a university hospital in Germany. We retrospectively reviewed the records of 170 patients treated mainly with electron-beam radiation to the vulva and Co-60 to the inguinal lymph nodes. Total doses to the vulva ranged from 6 to 90 Gy. A 30-year retrospective follow-up was accomplished. Tumor and node classification, tumor location, and parity were significant independent factors affecting survival. Actuarial survival was 52% for women with T1 disease, 25% for T2 disease, 10% for T3 tumors, and 0% for T4 tumors; survival with N0 tumors was 39% versus 13% with N2 lesions. Tumors of the labia minora were associated with a better survival rate (40.8% at 5 years) than were tumors at other locations (15%-21% at 5 years). Patients with zero to three children had significantly better results (32% at 5 years) than patients with four to seven children (11%). A dose of 60 Gy did not produce better long-term survival rates compared with lower doses, perhaps because low electron energy missed microscopic disease in deep vulvar tissues. On the basis of this review, patients with vulvar carcinoma should have at least a complete tumor resection. The therapeutic window between tumor control probability and the normal tissue complication rate in nonresected patients is too narrow: local recurrences are quite frequent with lower dose schedules, and survival rates are very poor, whereas complication rates are high with radical dose schedules that nevertheless provide acceptable cure rates.