Rotmensch J, Rubin S J, Sutton H G, Javaheri G, Halpern H J, Schwartz J L, Stewart M, Weichselbaum R R, Herbst A L
Department of Obstetrics and Gynecology, University of Chicago, Illinois 60637.
Gynecol Oncol. 1990 Feb;36(2):181-4. doi: 10.1016/0090-8258(90)90169-l.
A therapeutic alternative to exenteration for large locally advanced vulvar carcinoma involving the rectum, anus, or vagina is the use of preoperative radiation followed by radical surgery. Between 1980 and 1988, 13 patients with Stage III and 3 with Stage IV vulvar carcinoma involving the rectum/anus, urethra, or vagina were treated with 4000 rad to the vulva and 4500 rad to the inguinal and pelvic nodes followed by a radical vulvectomy and inguinal lymphadenectomy 4 weeks later. The overall 5 year cumulative survival was 45%. Twelve tumors regressed after radiation with 62.5% of the patients having visceral preservation while in 4 patients there was no major response to radiation and urinary or fecal diversion was required. Of the 6 recurrences 4 were central and 2 distant. Three patients with central recurrences had tumor within 1 cm of the vulvectomy margin. Complications included wet desquamation, inguinal wound separation, lymphedema, and urethral strictures. There were no operative deaths. It is concluded that the use of preoperative radiation followed by radical vulvectomy may be an alternative to pelvic exenteration in selected patients with advanced vulvar lesions.
对于累及直肠、肛门或阴道的局部晚期大型外阴癌，除了行外阴切除术外，一种治疗选择是术前放疗后再行根治性手术。1980年至1988年期间，13例Ⅲ期和3例Ⅳ期累及直肠/肛门、尿道或阴道的外阴癌患者接受了外阴4000拉德及腹股沟和盆腔淋巴结4500拉德的放疗，4周后行根治性外阴切除术和腹股沟淋巴结清扫术。总体5年累积生存率为45%。12例肿瘤放疗后缩小，62.5%的患者保留了脏器，4例患者对放疗无明显反应，需要进行尿路或粪便改道。6例复发患者中，4例为中心复发，2例为远处复发。3例中心复发患者的肿瘤位于外阴切除边缘1厘米范围内。并发症包括湿性脱皮、腹股沟伤口裂开、淋巴水肿和尿道狭窄。无手术死亡病例。结论是，对于部分晚期外阴病变患者，术前放疗后行根治性外阴切除术可能是盆腔脏器清除术的一种替代方法。
