Chemoradiation for advanced primary vulval cancer.

Area of Science:

• Gynaecological Oncology
• Radiation Oncology
• Medical Oncology

Background:

• Vulval cancer, a rare gynaecological malignancy, lacks a standard treatment for locally advanced stages (FIGO III-IV).
• Combined treatment modalities involving radiotherapy, chemotherapy, and surgery are used, but their comparative advantages and disadvantages are not well-established.

Purpose of the Study:

• To evaluate the effectiveness and safety of neoadjuvant and primary chemoradiation for locally advanced primary vulval cancer.
• To compare these chemoradiation approaches against other primary treatment modalities, including primary surgery or primary radiation.

Main Methods:

• Searched multiple databases (Cochrane CENTRAL, MEDLINE, EMBASE) and clinical trial registers up to July 2009.
• Included randomized controlled trials (RCTs) and non-randomized studies with multivariate analyses of chemoradiation for advanced vulval squamous cell carcinoma.
• Independently abstracted data, assessed risk of bias, and analyzed overall survival and adverse events using hazard ratios (HR) and risk ratios (RR).

Main Results:

• One RCT and two non-randomized studies (total 141 women) met inclusion criteria; all had a high risk of bias.
• Neoadjuvant chemoradiation did not improve survival compared to primary surgery (RR = 1.29, 95% CI 0.87-1.91).
• No significant survival difference was found between primary chemoradiation and primary surgery in two studies (pooled adjusted HR=1.09, 95% CI 0.37-3.17). Adverse events and quality of life were not adequately reported.

Conclusions:

• Current evidence suggests no significant difference in overall survival or adverse events between chemoradiation (neoadjuvant or primary) and primary surgery for advanced vulval cancer.
• High risk of bias in retrospective studies, variations in regimens, lack of quality of life data, and inconsistent terminology limit definitive conclusions.
• Standardized terminology and stratification by tumor unresectability are needed for high-quality comparative studies in advanced vulval cancer treatment.