Combined therapy as an alternative to exenteration for locally advanced vulvo-vaginal cancer: rationale and results.

Locally advanced vulvo-vaginal cancer is a difficult therapeutic problem complicated by the fact that it is an uncommon clinical entity. Surgery for the vulvar (external genital) phase of this disease presentation was combined with radiotherapy for the internal genital phase (with adequate overlap of fields to protect surgical margins). The rationale is that this approach treats the cancer and its dual regional spread patterns, while at the same time preserves the bladder and/or rectum, and should be associated with less morbidity and mortality than exenterative surgery, especially in this predominantly geriatric patient population. During the period from 1968-1980, 33 cancers have been treated. There were 26 primary and seven recurrent cases. The apparent advantages of this combined therapeutic approach over exenterative surgery include bladder and/or rectal preservation, low primary mortality, low treatment morbidity, and good results in cancer control.