Radiation Therapy for Vulva Cancer: A report of two cases

Abstract

     Vulva cancer is an uncommon disease. Surgical excision is the mainstay of treatment. Radiotherapy alone can also be considered depending on disease staging and patient condition, especially who are unfit for surgery.
     In this paper, we reported two patients with vulvar cancer who were treated with radiotherapy as a primary treatment during the period of 1^st January – 30^th September 2021 at Maharat Nakhon Ratchasima Hospital. The first patient was a 65-year-old woman who diagnosed with vulva cancer at least stage IB. She underwent radiotherapy using 70 Gray (Gy) in 35 fractions. Acute complications were febrile neutropenia, moist desquamation, and wound infection. The radiotherapy treatment had to delay for 5 days and the total treatment duration was 8 weeks instead of 7 weeks at pre-treatment planning. After treatment, the lesion was a complete response and disease free after 9 months follow-up. After that, the progression of right inguinal lymph node enlargement and multiple lung nodules were found. The second case was an 87-year-old woman who had underlying aortic stenosis disease and diagnosed with vulva cancer stage II. She was treated with radiation 54 Gray (Gy) in 18 fractions, converting dose to conventional fractionation (Equivalence dose as 2 Gy; EQD2) equal to 70.2 Gy. Minor complications were found and able to carry out the treatment as a planned total of 4 weeks. After treatment, the lesion was complete response (CR) and disease-free after 12 months of follow-up. The patient developed atrial fibrillation and congestive heart failure which was a cause of death, with no evidence of vulva cancer recurrence. Treatment with radiotherapy alone can get a high cure rate from disease but relatively short disease-free survival (DFS) at 9 months and 12 months. The treatment of radiotherapy alone is suitable for elderly patients who have multiple underlying diseases and are unfit for surgery.