Squamous-cell carcinoma of the vulva: locally advanced disease

About 30-40% of vulvar cancers present with International Federation of Gynecology and Obstetrics (FIGO) (clinical) stage III or IV disease. Although surgical staging was introduced by FIGO in 1988 and hard data on this system are still relatively few, a review of our own patients suggests that this percentage of patients with advanced stage vulvar cancer probably still holds. We have considered carcinoma of the vulva to be locally advanced when the primary or recurring tumour cannot be locally managed by a radical vulvar resection. Current approaches to the treatment of locally advanced vulvar cancer include ultraradical surgery, radiotherapy, chemo-radiotherapy and a combination of treatment modalities. This chapter reviews the current approaches to the treatment of locally advanced vulvar cancer.