The role of brachytherapy in the treatment of stage III vaginal cancer. A report of 3 cases.

Advanced vaginal cancer has a grim prognosis: management is complicated. It may include surgery which needs to be exenterative if cure is intended, and/or radiation therapy (RT), the dose of which is limited by the radiosensitivity of adjacent structures. We report on 3 cases, in each of which the tumor was located in different anatomic sites, and we demonstrate how therapy was tailored to each situation. All 3 patients had Stage III, squamous cell carcinoma of the vagina. They received external beam irradiation (EBI) 4000-5000 cGy to the pelvis. This is the maximal tolerable dose by most pelvic organs, but is not curative. Therefore brachytherapy was combined with EBI. In one patient brachytherapy was given intraoperatively, following extensive removal of residual tumor in the pelvis. Two patients are alive and free of disease three and six and a half years later, and one patient died of disease five years following therapy. For eradication of advanced vaginal cancer, treatment includes the combination of EBI and brachytherapy with or without debulking surgery, the role of which was not previously described in this setting. Treatment strategy should be adapted to the anatomic location of the tumor, its intravaginal extension and the age of the patient.