[Combined treatment for advanced vulvar cancer]

To investigate the combined treatment of surgery and radiotherapy as well as prognosis significance for advanced vulvar cancer.

Fourty-three cases of advanced vulvar cancer treated by surgery and pre- and post-operative radiation were retrospectively analysed. Twenty-nine patients were treated by preoperative radiotherapy with surgery, fourteen by surgery with postoperative irradiation. 43 patients were underwent radical vulvectomy with inguinal lymphadenectomy (20 cases) and with biopsies of inguinal lymph nodes (16 cases). Partial resection of vagina, distant urethra or anus were done concurrently with radical vulvectomy in 41 patients with adjacent organs invaded. The effects with various doses of radiation for local tumor were compared and the recurrences in patients with tumor resected completely and with microresidual disease after surgery were analysed.

The overall 5-yr survival rate was 45.0% for this group (by Kaplan-Meier). Patients received preoperative irradiation with dose maximum (Dm) > or = 40 Gy had a better tumor regression than with Dm < 40 Gy (75.0% vs 18.2%, P < 0.05). 4 out of 6 patients received postoperative irradiation Dm > 40 Gy were survived over 5-yr, in contrast, 2 out of 8 patients with Dm < or = 40 Gy were survived over 3 and 5 years respectively. The local recurrence rate was 25.0% in patients with no residual disease and 68.4% with microscopic tumor in the surgical margins or nearby (P < 0.05).

The results demonstrate that the dosage of irradiation and the thoroughness of radical surgery are the most important factors influencing the prognosis.