Gu Yan-Jun, Huang Ai-Wu, Xu Chang-Fen, Qian Li-Wen
Hangzhou Lin'an Traditional Chinese Medicine Hospital, Affiliated Hospital, Hangzhou City University, Hangzhou 311300, Zhejiang Province, China.
Department of Radiation Oncology, Sir Run Run Shaw Hospital, Hangzhou 310016, Zhejiang Province, China.
World J Clin Oncol. 2024 Aug 24;15(8):1102-1109. doi: 10.5306/wjco.v15.i8.1102.
Primary vaginal cancer is rare and most vaginal tumors are metastatic, often arising from adjacent gynecologic structures. Primary vaginal cancers are also more common among postmenopausal women and most of these are squamous cell carcinomas, with adenocarcinomas being relatively rare. Vaginal bleeding is the most common clinical manifestation of vaginal adenocarcinoma. About 70% of vaginal adenocarcinomas are stage I lesions at the time of diagnosis, for which radical surgery is recommended. However, more advanced vaginal cancers are not amenable to radical surgical treatment and have poor clinical outcomes. Optimal treatments modes are still being explored. Here, we report a rare case of stage IIb primary vaginal adenocarcinoma for which an individually designed vaginal applicator for after-loading radiotherapy was used to achieve good tumor control.
A 62-year-old woman presented to our clinic after 3 months of abnormal postmenopausal vaginal bleeding. Gynecological examination, computed tomography (CT), and positron emission tomography-CT showed a large mass (about 5 cm) on the anterior vaginal wall. Colposcopy biopsy confirmed adenocarcinoma of vaginal origin. After three cycles of carboplatin plus paclitaxel chemotherapy, the lesion partially shrunk. The patient then received external irradiation of 45 gray (gy) in 25 fractions, which further reduced the vaginal lesion, followed by after-loading radiotherapy of 30 gy in 5 fractions with an individually designed vaginal applicator. Three months later, magnetic resonance imaging showed a slight thickening of the anterior vaginal wall.
Primary vaginal adenocarcinoma is rare, and prognosis is poor in most vaginal cancers of locally advanced stages, which cannot be treated with radical surgery. Better tumor control can be achieved with an individualized vaginal applicator that allows administration of a higher radical dose to the tumor area while protecting normal tissues.
原发性阴道癌较为罕见，大多数阴道肿瘤是转移性的，常起源于邻近的妇科结构。原发性阴道癌在绝经后女性中也更常见，其中大多数是鳞状细胞癌，腺癌相对少见。阴道出血是阴道腺癌最常见的临床表现。约70%的阴道腺癌在诊断时为I期病变，对此推荐行根治性手术。然而，更晚期的阴道癌不适合根治性手术治疗，临床结局较差。最佳治疗模式仍在探索中。在此，我们报告一例罕见的IIb期原发性阴道腺癌病例，使用个体化设计的后装放疗阴道施源器实现了良好的肿瘤控制。
一名62岁女性在绝经后阴道异常出血3个月后就诊于我院。妇科检查、计算机断层扫描（CT）和正电子发射断层扫描-CT显示阴道前壁有一个大肿块（约5 cm）。阴道镜活检确诊为原发性阴道腺癌。在接受三个周期的卡铂加紫杉醇化疗后，病变部分缩小。随后患者接受了25次分割、总量45格雷（Gy）的外照射，这进一步缩小了阴道病变，之后使用个体化设计的阴道施源器进行了5次分割、总量30 Gy的后装放疗。三个月后，磁共振成像显示阴道前壁轻度增厚。
原发性阴道腺癌罕见，大多数局部晚期阴道癌预后较差，无法行根治性手术治疗。使用个体化阴道施源器可在保护正常组织的同时，向肿瘤区域给予更高的根治剂量，从而实现更好的肿瘤控制。
