Local control is a problem with bulky tumors. In recent years, some investigators have also used concurrent chemotherapy with agents such as cisplatin, bleomycin, mitomycin-C, floxuridine, and vincristine; but this practice has not been proven to improve outcomes. It is an extrapolation from treatment approaches used in cervical cancer, based on shared etiologic and risk factors.
For patients with stage IVB or recurrent disease that cannot be managed with local treatments, current therapy is inadequate. No established anticancer drugs can be considered of proven clinical benefit, although patients are often treated with regimens used to treat cervical cancer. (Refer to the PDQ summary on Cervical Cancer Treatment for more information.)
Concurrent chemotherapy, using 5-fluorouracil or cisplatin-based therapy, and radiation are sometimes advocated, again based solely on extrapolation from cervical cancer management strategies.[6,7,8] Experience is limited to small case series and the incremental impact on survival and local control is not well defined.[Level of evidence 3iiiDiv] Because of the rarity of these patients, they should be considered candidates for clinical trials of anticancer drugs and/or radiosensitizers to attempt to improve survival or local control.
Management of the extremely rare vaginal clear cell carcinoma is generally similar to the management of squamous cell carcinoma, though techniques that preserve vaginal and ovarian function are given strong consideration in treatment planning, given the young average age at diagnosis.
In light of the many uncertainties about the relative efficacy of treatment approaches, ongoing clinical trials should be discussed with patients if they are eligible. Information about ongoing clinical trials is available from the NCI Web site.
As is the case with other gynecologic malignancies, the evidence base for surveillance after initial management of vaginal cancer is weak because of a lack of randomized, or even prospective, clinical studies. There is no reliable evidence that routine cytologic or imaging procedures in patients improve health outcomes beyond what is achieved by careful physical examination and assessment of new symptoms. Therefore, outside the investigational setting, imaging procedures may be reserved for patients in whom physical examination or symptoms raise clinical suspicion of a recurrence or progression.
- Eifel PJ, Berek JS, Markman MA: Cancer of the cervix, vagina, and vulva. In: DeVita VT Jr, Lawrence TS, Rosenberg SA: Cancer: Principles and Practice of Oncology. 9th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2011, pp 1311-44.
- Frank SJ, Jhingran A, Levenback C, et al.: Definitive radiation therapy for squamous cell carcinoma of the vagina. Int J Radiat Oncol Biol Phys 62 (1): 138-47, 2005.
- Tran PT, Su Z, Lee P, et al.: Prognostic factors for outcomes and complications for primary squamous cell carcinoma of the vagina treated with radiation. Gynecol Oncol 105 (3): 641-9, 2007.
- Stock RG, Chen AS, Seski J: A 30-year experience in the management of primary carcinoma of the vagina: analysis of prognostic factors and treatment modalities. Gynecol Oncol 56 (1): 45-52, 1995.
- Chyle V, Zagars GK, Wheeler JA, et al.: Definitive radiotherapy for carcinoma of the vagina: outcome and prognostic factors. Int J Radiat Oncol Biol Phys 35 (5): 891-905, 1996.
- Grigsby PW: Vaginal cancer. Curr Treat Options Oncol 3 (2): 125-30, 2002.
- Dalrymple JL, Russell AH, Lee SW, et al.: Chemoradiation for primary invasive squamous carcinoma of the vagina. Int J Gynecol Cancer 14 (1): 110-7, 2004 Jan-Feb.
- Samant R, Lau B, E C, et al.: Primary vaginal cancer treated with concurrent chemoradiation using Cis-platinum. Int J Radiat Oncol Biol Phys 69 (3): 746-50, 2007.
- Senekjian EK, Frey KW, Anderson D, et al.: Local therapy in stage I clear cell adenocarcinoma of the vagina. Cancer 60 (6): 1319-24, 1987.
- Salani R, Backes FJ, Fung MF, et al.: Posttreatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncologists recommendations. Am J Obstet Gynecol 204 (6): 466-78, 2011.