Erfahrungen und Ergebnisse bei der Behandlung von Rezidiven des Vulvakarzinoms

Abstract

Illness amounting to relapse occurred in 82 of the 268 patients treated from 1973 through 1993 for primary malignancy of the vulva by the Department of Gynaecology and Obstetrics, University of Leipzig. Local tumour persistence (≤6 months after primary therapy) was diagnosed in 34 patients. 48 patients experienced a,,true relapse. Nearly 2 /3 of all vulvocarcinoma, recurrences were discovered within the first year after primary therapy. Of the 82 patients suffering from relapse illness, 39 showed a local recurrence in the area of the secondary vulva (47.6%). 16 displayed strictly regional recurrence (19.5%), and 27 exhibited both a local and a regional recurrence (32.9%). Relapse therapy included follow-up operations in 33 cases (40.3%). 20 simple repeated vulvectomies were performed, as well as 3 repeated vulvectomies with both partial excision of vagina, urethra and/or sphincter and plastic defect covering, 6 local relapse resections in the area of the vulva, and 4 simple inguinal lymph node dissections. In contrast, the remaining 49 patients (59.7%) were treated via non-operative relapse therapy. 16 of these patients were provided with individualised radiation therapy according to tumour site and expansion (19.5%). 33 patients, suffering from extensive tumour spreading and found to be in very poor general health, were merely treated for symptoms (40.2%). In 17 out of the 49 patients treated either operatively and/or with for initial relapse illness (34.7%), a second relapse occurred on the average after 12.8 months. Calculated from the time of tumour reappearance (p 2cm). During the first two years following primary therapy, follow-up examinations should be performed every 3 months and comprise both clinical and colposcopic evaluations of the vaginal introitus.