Patients should be followed carefully to detect recurrent disease as early as possible. Both treatment and outcome depend on the site and extent of recurrence.[1] Radical excision of localized recurrence provides an approximate 5-year survival rate of 56% when the regional nodes are not involved.[2] Palliative radiation therapy is used in some patients. Radiation therapy with or without 5-FU may be curative in some patients with a small local recurrence.[3,4,5] When local recurrence occurs more than 2 years after primary treatment, a combination of radiation therapy and surgery may result in a 5-year survival rate of greater than 50%.[6,7]

STANDARD TREATMENT OPTIONS:

1. Wide local excision with or without radiation in those patients with local recurrence.
2. Radical vulvectomy and pelvic exenteration.
3. Synchronous radiation and cytotoxic chemotherapy with or without surgery.[4]

There is no standard chemotherapy or other systemic treatment effective in patients with metastatic disease. Such patients should be considered for clinical trials.

TREATMENT OPTIONS UNDER CLINICAL EVALUATION:

• Clinical trials. Information about current clinical trials is available on the NCI Web site.

Current Clinical Trials

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent vulvar cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.

General information about clinical trials is also available from the NCI Web site.

References:

1. Piura B, Masotina A, Murdoch J, et al.: Recurrent squamous cell carcinoma of the vulva: a study of 73 cases. Gynecol Oncol 48 (2): 189-95, 1993.
2. Hopkins MP, Reid GC, Morley GW: The surgical management of recurrent squamous cell carcinoma of the vulva. Obstet Gynecol 75 (6): 1001-5, 1990.
3. Miyazawa K, Nori D, Hilaris BS, et al.: Role of radiation therapy in the treatment of advanced vulvar carcinoma. J Reprod Med 28 (8): 539-41, 1983.
4. Russell AH, Mesic JB, Scudder SA, et al.: Synchronous radiation and cytotoxic chemotherapy for locally advanced or recurrent squamous cancer of the vulva. Gynecol Oncol 47 (1): 14-20, 1992.
5. Thomas G, Dembo A, DePetrillo A, et al.: Concurrent radiation and chemotherapy in vulvar carcinoma. Gynecol Oncol 34 (3): 263-7, 1989.
6. Podratz KC, Symmonds RE, Taylor WF, et al.: Carcinoma of the vulva: analysis of treatment and survival. Obstet Gynecol 61 (1): 63-74, 1983.
7. Shimm DS, Fuller AF, Orlow EL, et al.: Prognostic variables in the treatment of squamous cell carcinoma of the vulva. Gynecol Oncol 24 (3): 343-58, 1986.