Objective: To analyse the outcome of various treatments for vulvar cancer and to investigate the characteristics of the recurrence and metastasis.
Methods: A total of 309 patients with carcinoma of vulva were analyzed retrospectively.
Results: The overall 5-year survival rate was 67.9%. That for stage I, II, III and IV was 86.9%, 82.5%, 59.2% and 43.6%, respectively. Treatment failure was seen in 49.8% of the treated cases, and it occurred within 2 years after primary treatment in the majority of the cases. Inguinal and pelvic recurrences, and distant metastases occurred within 2 years, while local recurreuce mostly after 2 years. Recurrence rate was not related to age of the patients. For stage I cancer, there was no difference in the results of different methods of treatment, but for stage II cancer, wide local resection plus inguinal lymphadenectomy was a better choice. In patients with regional lymph node metastases treated by nodal resection, it was less likely to recur than did radiotherapy. If no nodal involvement, the outcome of the two types of treatment was not different. Higher dose of radiation (Dm > or = 60 Gy) was better than lower dose (40-50 Gy) for prevention of recurrence.
Conclusion: For early stage vulvar cancer, in addition to radical resection of vulva, preventive dissection of inguinal lymph nodes, or full dose radiation of the inguinal region, leads to better therapeutic results. For advanced cases, radical resection of the primary tumor with pre- and post-operative radiation, and inguinal lymph nodal disection, whenever possible, should be performed.