Radiotherapie bei Vulva- und Vaginalkarzinom

Background
Therapeutic strategies for vulvar and vaginal cancer comprise surgery, radiotherapy, or combined radiochemotherapy. These modalities differ especially in terms of side effects and complications. Due to the prognostic relevance of lymph node metastasis in vulvar cancer, staging and treatment of the inguinal and pelvic lymphatic drainage areas is of particular importance. In addition, the different side effect profiles must be taken into account.

Objective
The aim of this study was to conduct an evidence-based systematic review of the current status of radiotherapy for vulvar and vaginal cancer.

Materials and methods
The available literature for the two tumor entities was evaluated, and treatment recommendations are proposed depending on different clinical scenarios.

Results
In early stages, the standard primary treatment for vulvar cancer is surgery. Radiotherapy is applied in the postoperative setting depending on risk factors, or is used in locally advanced disease as definitive treatment or as preoperative radio(chemo)therapy to improve resectability. Positive inguinal (and pelvic) lymph nodes have been proven to be the most important prognostic factors for affected patients. At present, only patients with two or more positive lymph nodes are treated with adjuvant radiotherapy; however, patients with one lymph node metastasis might also benefit from adjuvant therapy. Given the rarity of vulvar cancer, recommendations are based largely on retrospective studies.

Conclusion
Due to the rising incidence of vulvar and vaginal cancer, especially in younger women, the goal is to improve locoregional tumor control while minimizing perioperative morbidity and maximizing long-term psychosexual and physical wellbeing. As many open questions remain, physicians should recommend that eligible patients participate in clinical trials.