Malignant tumors of the vagina.

Abstract

A retrospective analysis of 118 patients with malignant tumors of the vagina shows that the prognosis, following adequate irradiation, is similar to cornparable stages of carcinoma of the cervix. The 5-year absolute cure rate was 75% for Stage I, 50% for Stage JIA, and about 25% for Stages IIB, 111, and IV. The patients were retrospectively staged according to the system adopted by the International Federation of Gynecology and Obstetrics. It is proposed that the Stage I1 lesions be subdivided into IIA (paravaginal submucosal extension only) and IIB (parametrial extension), since the prognosis is distinctly different in these patients. Otherwise, the prognosis correlates well with the various clinical stages. Tumor control was excellent in the in-situ and early invasive lesions treated by radium alone or combined with external beam in Stage I lesions. Local and pelvic failures were more frequently seen in tumors more extensive than Stage IIA. Well-planned irradiation, with the aid of computer calculations, will significantly increase tumor control. This is best achieved by combining interstitial and intracavitary vaginal radium and external beam supervoltage irradiation to the pelvic and parametrial tissues. The importance of careful follow-up after irradiation and the early treatment of recurrent lesions is emphasized since a number of these patients can be salvaged by a subsequent surgical procedure. The most significant factor affecting the prognosis was the stage of the disease, which was related to the depth of infiltration of the tumor in the vaginal wall or adjacent tissues. Age of the patient, location, or extent of mucosal involvement did not significantly influence the prognosis.