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Stage I Vaginal Cancer

    The treatments listed below have not been directly compared in randomized trials.[Level of evidence 3iiiD] Because of differences in patient selection, local expertise, and staging criteria, it is difficult to determine whether there are differences in disease control rates.

    Squamous Cell Carcinoma

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    Standard treatment options for superficial lesions less than 0.5 cm thick:

    1. Radiation therapy.[1,2,3,4] These tumors may be amenable to intracavitary brachytherapy alone,[1] but some centers nearly always begin with external-beam radiation therapy (EBRT).[2] EBRT is required for bulky lesions or lesions that encompass the entire vagina).[1] For lesions of the lower third of the vagina, elective radiation therapy is often administered to the patient's pelvic and/or inguinal lymph nodes.[1,2]
    2. Surgery.[5] Wide local excision or total vaginectomy with vaginal reconstruction, especially in lesions of the upper vagina. In cases with close or positive surgical margins, adjuvant radiation therapy is often added.[6]

    Standard treatment options for lesions greater than 0.5 cm thick:

    1. Surgery.[5] In lesions of the upper third of the vagina, radical vaginectomy and pelvic lymphadenectomy should be performed. Construction of a neovagina may be performed if feasible and if desired by the patient.[6,7] In lesions of the lower third, inguinal lymphadenectomy should be performed. In cases with close or positive surgical margins, adjuvant radiation therapy should be considered.[6]
    2. Radiation therapy.[1,2,3,4] EBRT [2] and/or combination of interstitial and intracavitary therapy to a dose of at least 75 Gy to the primary tumor.[1,8] For lesions of the lower third of the vagina, elective radiation therapy of 45 Gy to 50 Gy is given to the pelvic and/or inguinal lymph nodes.[1,2]

    Adenocarcinoma

    Standard treatment options:

    1. Surgery. Because the tumor spreads subepithelially, total radical vaginectomy and hysterectomy with lymph node dissection are indicated. The deep pelvic nodes are dissected if the lesion invades the upper vagina, and the inguinal nodes are removed if the lesion originates in the lower vagina. Construction of a neovagina may be performed if feasible and if desired by the patient.[6] In cases with close or positive surgical margins, adjuvant radiation therapy is often given.[6,7]
    2. Intracavitary and interstitial radiation as previously described for squamous cell cancer.[1] For lesions of the lower third of the vagina, elective radiation therapy of 45 Gy to 50 Gy is given to the pelvic and/or inguinal lymph nodes.[1,9]
    3. Combined local therapy in selected cases, which may include wide local excision, lymph node sampling, and interstitial therapy.[10]
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