vaginal cancer

Question 1

What are the treatment options for a stage 1 vaginal cancer

Answer 1

Stage 1 = confined to the vaginal wall

Tx:
WLE +/- adj RT
Brachytherapy alone, if confined to superficial mucosa
CRT +/- brachy

Question 2

What are the treatment options for a stage 2-3 vaginal cancer

Answer 2

Stage 2 = involving paravaginal tissues
Stage 3 = involvement of pelvic sidewall

Tx:
CRT +/- brachy
Surgery +/- adj RT

Question 3

What are the treatment options for a stage 4a vaginal cancer

Answer 3

Stage 4a = Invasion into bladder or rectum, or out of true pelvis

Tx - non-curative:
CRT +/- brachy
Surgery +/- adj RT

Question 4

What is the CRT regimen for a vaginal cancer

Answer 4

Phase 1: 45Gy/25#

Phase 2:
HDR brachytherapy - 21Gy/3# prescribed to 0.5cm depth

Question 5

What is the CTV when treating a vaginal cancer
What is the CTV to PTV margin

Answer 5

CTV-T = GTV +1-2cm, and whole vagina
CTV-T-PTV margin - 1cm for lower 1/3, 1.5cm for upper 2/3

CTV-N - PTV margin - 0.8cm

Question 6

What nodal volume should be included for RT to a vaginal cancer

Answer 6

If upper 2/3 vagina: int/ext/common iliacs, pre-sacral and obturator nodes

If lower 1/3 vagina: femoral, inguinal and distal ext/int iliacs

Question 7

What is the treatment for a recurrent vaginal cancer

Answer 7

Usually loco-regional
Previous RT -> Pelvic exenteration
Previous surgery alone -> radical RT

Question 8

What are poor prognostic factors for a vaginal cancer

Answer 8

Lower 1/3
Disease bulk
Non-clear cell adenocarcinoma

Question 9

What are good prognostic factors for a vaginal cancer

Answer 9

Young age (<60)
Early stage
HPV positive
Total RT dose >70Gy

Question 10

What is the treatment for clear cell adenocarcinoma

Answer 10

Surgery and RT