Radiation in Vaginal Cancer

Primary vaginal cancer is a rare cancer, accounting for approximately 3% of all gynecological malignancies. The predominant histologic subtype in primary vaginal cancer is squamous carcinoma (90%). Adenocarcinoma accounts for about 8–10% of cases. The introduction of HPV vaccination as a primary prevention strategy in cervical cancer has also been shown to reduce the prevalence of noncervical premalignant lesions among vaccinated women. Most tumors occur in the upper third of the vagina, especially the posterior wall. The FIGO Gynecologic Oncology Committee recommends that wherever available, imaging should be used to better define tumor volume and extension of disease. As extrapolated from cervical cancer, MRI is more sensitive in detecting tumor size, as well as paravaginal or parametrial involvement. Primary treatment with surgery is limited to early and small lesions confined to the vaginal mucosa (less than 2 cm). Standard Therapy FIGO II-III is radiochemotherapy. Pelvic exenteration is a possibility if the recurrence is central and isolated (FIGO IV). A combination of external beam radiation (EBRT) and brachytherapy in combination with chemotherapy is treatment standard. Optimal or lower threshold dose is 70 Gy, which showed improved outcomes. Image-guided adaptive brachytherapy extrapolated from cervical cancer treatment strategies results in better local control, with equal or less severe toxicity.