Objective: To retrospectively investigate the outcome and toxicity of concurrent chemo-radiotherapy in the treatment of locally advanced vulvar cancer (Lavc). Patients and Methods: Between 1996 and 2007, 28 consecutive patients with LAVC were treated with chemoradiation (20 primary tumors and 8 loco-regional recurrences). Treatment consists of 2 separate courses of external-beam radiotherapy (40 Gy-2 weeks split-20 Gy). During each course of radiotherapy, 5-fluorouracil (1000 mg/m2/d), was given as a continuous intravenous infusion over the first 4 days, and mitomycin-C (10 mg/m2 on day 1), as a bolus intravenous injection. Outcome measures were rates of complete and partial response, loco-regional control, progression-free survival, overall survival, and toxicity. Results: The median follow-up was 42 months and the median age of patients was 68 years. Twenty patients (72%) achieved complete remission, 4 patients (14%) partial remission, for an overall response rate of 86%. Four patients (14%) had progressive disease directly after chemo-radiotherapy. The actuarial rates of loco-regional control, progression-free survival and overall survival at 4 years were 75%, 71%, and 65%, respectively. There was no treatment break for acute toxicity. Vulvar desquamation was the main acute treatment-related side effect (93%). Three patients developed transient grade 2 neutropenia or thrombocytopenia. Mild skin fibrosis and atrophy (n = 6, 21%), radiation ulcer (n = 4, 14%, in one patient treatment was needed), telangectasia (n = 3, 11%), and lymphoedema (n = 2, 7%) were the most common late toxicity of chemoradiation. Conclusion: These data support the use of concurrent chemoradiotherapy as an effective alternative to primary ultra-radical surgery to treat LAVC with an acceptable toxicity profile.

5-fluorouracil, adult, advanced cancer, aged, article, blood toxicity, cancer combination chemotherapy, cancer control, cancer localization, cancer radiotherapy, cancer recurrence, cancer regression, cancer survival, carcinoma of the vulva, chemo-radiotherapy, chemoradiotherapy, clinical article, continuous infusion, desquamation, diarrhea, external beam radiotherapy, female, femur head necrosis, fluorouracil, follow up, hip arthroplasty, human, locally advanced disease, lymphedema, micturition disorder, mitomycin C, nausea, neutropenia, overall survival, progression free survival, radiation dose, radiation injury, rectum hemorrhage, retrospective study, skin atrophy, skin fibrosis, skin ulcer, survival rate, telangiectasia, thrombocytopenia, treatment outcome, treatment response, urethra stricture, urine incontinence, urine retention, vulva carcinoma, vulva desquamation, vulva disease
dx.doi.org/10.1097/COC.0b013e3181cae6a1, hdl.handle.net/1765/23393
American Journal of Clinical Oncology
Erasmus MC: University Medical Center Rotterdam

Tans, L, Ansink, A.C, van Rooij, P.H, Kleijnen, C, & Mens, J.W.M. (2011). The role of chemo-Radiotherapy in the management of locally advanced carcinoma of the vulva: Single institutional experience and review of literature. American Journal of Clinical Oncology, 34(1), 22–26. doi:10.1097/COC.0b013e3181cae6a1