Vulvar cancer is rare and not much is known how to optimally manage it after recurrence. Surgery should be sued henever possible. Radiation therapy with or without chemotherapy can produce prolonged disease-free periods in some patients with a limited local recurrence. If the disease has come back after two years, chemoradiation and surgery can produce a 5-year survival rate of greater than 50%. Much of this literature is two or more decades old.
NHS says: “Cytotoxic chemotherapy is not regarded as standard treatment in the management of vulvar cancers but can be used in selected patients with metastatic disease. The drugs of choice are 5-Fluorouracil and cisplatin, alone or in combination. Single agent Taxol is considered in patients who progress after first line chemotherapy. The response rate to chemotherapy is low and the duration of response of the order of 3-6months.Some patients particularly those with local vulvar relapse can be salvaged with further surgery. Generally patients with nodal and/or distant failure have poor prognosis and palliative treatments are appropriate. Selected patients may be considered on an individual basis for more aggressive treatment.”
This indiviudalized and conservative approach appears to be supported by what we know and what we do not know.
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