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PubMed1988

DNA analysis cervical and vaginal cancer cells during radiotherapy by rapid high-resolution cytometry.

The DNA content of the nuclei of cancer cells of 12 cases of cervical cancer and 2 cases of vaginal cancer, treated with radiotherapy, were studied in 50 specimens. Specimens were taken from each case before radiotherapy and at the totals of 1,000 rad, 2,000 rad, 3,000 rad and 4,500 rad (or 5,000 rad). All specimens were stained by the Papanicolaou method and were analyzed by rapid high-resolution cytometry. Total optical density, mean nuclear area and the 5N-exceeding rate (5NER) increased gradually following irradiation. Cancer cells disappeared in good response cases before 3,000 rad. Eight smears with a 5NER under 100 at the dose of 3,000 rad or more seemed to be poor response cases. Low 5NER and low mean nuclear areas were observed in both patients who died with persistent disease after radiotherapy, as well as in one case treated with chemotherapy for persistent disease after radiotherapy.

Adult↗
PubMedDate not supplied

Stage II vaginal cancer responding to chemotherapy with irinotecan and cisplatin: a case report.

We report a patient with stage II primary vaginal cancer whose tumor disappeared on magnetic resonance imaging after a single course of neoajuvant chemotherapy using irinotecan and cisplatin. The regimen was 60 mg/m2 of cisplatin (day 1) and 60 mg/m2 of irinotecan (days 1, 8, 15). After addition of 1 course of cisplatin alone, radical surgery was performed. Histological examination of the excised tissue revealed no cancer cells. This is the first report on the good efficacy of chemotherapy with irinotecan and cisplatin for advanced vaginal cancer.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1982

Combined therapy as an alternative to exenteration for locally advanced vulvo-vaginal cancer: rationale and results.

Locally advanced vulvo-vaginal cancer is a difficult therapeutic problem complicated by the fact that it is an uncommon clinical entity. Surgery for the vulvar (external genital) phase of this disease presentation was combined with radiotherapy for the internal genital phase (with adequate overlap of fields to protect surgical margins). The rationale is that this approach treats the cancer and its dual regional spread patterns, while at the same time preserves the bladder and/or rectum, and should be associated with less morbidity and mortality than exenterative surgery, especially in this predominantly geriatric patient population. During the period from 1968-1980, 33 cancers have been treated. There were 26 primary and seven recurrent cases. The apparent advantages of this combined therapeutic approach over exenterative surgery include bladder and/or rectal preservation, low primary mortality, low treatment morbidity, and good results in cancer control.

Adult↗
PubMed2006

Low-dose warfarin does not decrease the rate of thrombosis in patients with cervix and vulvo-vaginal cancer treated with chemotherapy, radiation, and erythropoeitin.

OBJECTIVES: We had previously reported an association between the use of recombinant human erythropoietin (rHuEPO) and thrombosis in patients with cervix and vulvo-vaginal cancer treated with chemotherapy and radiation. We hypothesized that low-dose warfarin would be effective prevention for thromboembolic events in this setting. METHODS: A retrospective analysis of patients with cervical or vulvo-vaginal carcinoma receiving chemoradiation and rHuEpo was performed. Thirty-two patients received rHuEpo alone, and 24 received warfarin (1-2 mg) and rHuEpo. The primary endpoint was objectively proven symptomatic venous thrombosis. RESULTS: There was no difference in the baseline characteristics (e.g. age, stage, body mass index, mean and peak hemoglobin, WBC and platelet counts, and number of transfusions) between these two groups. The rate of thrombosis also was not statistically different (P = 0.62). Nine of 24 patients had a symptomatic deep vein thrombosis (DVT) while receiving warfarin compared to 10 of 32 patients not on warfarin. There was no difference between the two groups in the percentage of patients with upper extremity DVT (P = 0.83) or lower extremity DVT (P = 0.64). CONCLUSION: Daily low-dose warfarin did not alter the incidence of symptomatic DVT in patients with cervical or vulvo-vaginal cancer who received rHuEpo in conjunction with chemoradiation.

Anticoagulants↗
PubMed1998

Descriptive epidemiology of vulvar and vaginal cancers in Vaud, Switzerland, 1974-1994.

BACKGROUND: To analyse trends in incidence, survival and risk of second neoplasms following vaginal and vulvar cancers using data collected by the Swiss Cancer Registry of Vaud over the 21-year period 1974-1994. MATERIALS AND METHODS: Subjects were 257 vulvo-vaginal cancers. Of these, 69 were vaginal, 153 vulvar cancers, and 35 non-specified lower genital tract neoplasms; 94 in situ neoplasms were also registered (85 for the vulva). RESULTS: Invasive vaginal cancer incidence decreased from 0.8 in 1974-1984 to 0.4/100,000 women in 1985-1994, while invasive vulvar cancer incidence remained approximately stable around 1.2/100,000 (world standard); incidence of in situ vulvar cancer increased from 0.8 to 1.3/100,000, the rise being larger in younger women. Significant excesses for second primary neoplasms were observed for pro-pharyngeal and lung cancer, and for non-melanomatous skin neoplasms, as well as for invasive vulvar cancers following in situ cancers. CONCLUSIONS: This population-based dataset confirms that the incidence of in situ vulvar (but not invasive vulvar or vaginal cancer) has been increasing over the last 20 years. The excess second primary neoplasms supports the hypotheses that human papillomavirus and cigarette smoking are related to vulvo-vaginal neoplasms.

Adult↗
PubMed1998

Risk of endometrial, ovarian, vulvar, and vaginal cancers after a positive cervical cytology followed by negative histology.

OBJECTIVE: To estimate the subsequent incidence of cancers of endometrium, ovary, vulva, and vagina among women with positive cytology at screening for cervical cancer followed by negative histology. METHODS: This was a longitudinal cohort study involving women attending the organized mass screening in Finland from 1971-1990 with class II, III, IV, or V cytology followed by negative histologic confirmation, and a sample of 42,844 women attending the organized mass screening in Finland in 1971-1976 with cytologic class I smears without any gynecologic symptoms or infections. Follow-up on the women to the end of 1994 for subsequent cancers was maintained by linkage to the national cancer registry. Standardized incidence ratios with 95% confidence intervals (CI), with rates for all of Finland as reference, were estimated. RESULTS: The standardized incidence ratios after negative class I smears of all the cancers studied were between 0.9 and 1.0. Ovarian cancer was not associated with positive cervical cytology. After positive class III-V cytology, the standardized incidence ratio of endometrial carcinoma was 1.6 (CI 1.0, 2.2) and that of vulvar carcinoma was 5.8 (CI 2.3, 12). The standardized incidence ratios of vaginal cancer after class II and III-V cytological smear were 2.7 (CI 1.7, 4.1) and 16.4 (CI 7.1, 32), respectively. The relative risks of all the cancers studied were greatest during the first year of follow-up and persisted for more than 5 years for vulvar and vaginal cancers. CONCLUSION: Although the Papanicolaou smear is poor in detecting cancers other than cervical, in clinical practice, the possibility of other gynecologic cancer has to be considered in surveillance after positive cervical cytology is followed by negative histology.

Adult↗
PubMed1991

Vaginal cancer: the role of infectious and environmental factors.

Primary cancers of the vagina are rare. They comprise 1% to 2% of all gynecologic malignancies and occur predominantly in older women. The diagnosis of primary carcinoma of the vagina requires that the cervix and vulva be intact and that no clinical evidence of other primary tumors exist. Approximately 90% of all vaginal tumors are squamous cell in type on histologic examination. Adenocarcinoma, which is much less common (2% to 4%), is seen primarily in younger women with in utero exposure to diethylstilbestrol. In addition to exposure to diethylstilbestrol, other environmental factors have been associated with the development of vaginal tumors, including chronic irritation from pessaries, previous hysterectomy for benign disease, immunosuppression therapy, cervical irradiation, and endometriosis. Infectious causes seem to play an even more pernicious role in vaginal cancer. The two agents most often implicated are herpes simplex virus and human papillomavirus. These viruses appear to serve as cofactors in the inducement of various genital cancers, working together or with environmental agents such as diethylstilbestrol and host-related genetic abnormalities. The prognosis of vaginal cancer depends on the stage of the disease, with an overall 5-year survival rate of 80% to 90% for early stages.

Adenocarcinoma↗
PubMed2005

Radiotherapy for the treatment of primary vaginal cancer.

Disease control rates and toxicity were evaluated among 28 primary vaginal cancer patients treated with curative intent using radiotherapy. At 5 years, the majority (60%) of patients were disease-free and local control was 73% when a combination of external beam radiotherapy and brachytherapy were used. Serious late toxicity was seen in 11% of patients.

Adult↗
PubMed1989

Promoting effect of croton oil on the induction of cervical and vaginal cancers with herpes simplex virus types 1 and 2 in mice.

Hybrid Swiss virgin mice (Kuan-min strain) were challenged intravaginally with uv-inactivated herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2) twice a week for 16 times and subsequently with croton oil or control medium twice a week for 27 times. After a period of 180 days the exposure to HSV-2 plus control medium induced premalignant and malignant lesions of the cervix and vagina in 50.0% of the mice. The exposure to HSV-2 plus croton oil induced similar lesions in 78.2% of the mice. The exposure to HSV-1 combined with either control medium or croton oil induced lesions in 37.2 and 58.3% of the mice, respectively. No malignant lesions were found in the control mice. These results reveal that (1) HSV-1 and HSV-2 have a similar oncogenic potential, and (2) croton oil can promote the induction of cervical and vaginal cancers with HSV-1 and HSV-2. Additionally, these results suggest that the virus-induced carcinogenesis of cervix and vagina might be similar to the classical two-stage carcinogenesis model. This animal model seems to be more suitable for studying the prevention and treatment of cervical and vaginal cancers because the period of this experiment is significantly shorter than that of experiments reported by other investigators and the frequency of the malignant lesion is significantly higher than or similar to that of the same lesion reported in other experiments.

Animals↗
PubMed2005

Vaginal cancers.

PURPOSE OF REVIEW: Vaginal neoplasia is one of the rarest of malignancies. Intraepithelial lesions are usually first identified by an abnormal Pap smear in a woman without a cervix. Surgery or ablation of the epithelium is usually highly successful. RECENT FINDINGS: There have not been any findings of significance since 2003 to include in this review. SUMMARY: Invasive cancer is usually located in the upper one-third of the vagina. If staged early, radical surgery can be curative as well as radiation therapy. Like cervical cancer, a more advanced stage is treated with radiation therapy, but with poorer survival rates than cervical cancer.

Carcinoma in Situ↗
PubMed2002

Efficacy and toxicity of MDR versus HDR brachytherapy for primary vaginal cancer.

The retrospective analysis includes a group of 50 patients with primary, invasive vaginal cancer treated with brachytherapy in the period of 1982-1993. Over 80% cases were squamous cell carcinoma. There were 14 patients in stage I according to FIGO classification and 20%, 36%, and 16% of patients in stage II, III and IV, respectively. Twenty one patients (42%) received MDR brachytherapy using Cs137 source, the remaining 29 (58%) were treated with HDR using Co60 or Ir192 sources. Among 50 patients 31 (62%) received also external beam irradiation. An overall 5-year actuarial disease-free survival was 40%, and it was 78.6% (11/14), 40% (4/10), 27.8% (5/18), 0% (0/8) for stage I, II, III and IV, respectively. For MDR or HDR5-year disease-free survival was 38% and 41%, respectively. No influence of dose rate on survival has been found (p=0.7). Local failure occurred in 20 patients (40%). Recurrences appeared in 10 patients (20%). Late complications rate was 0% and 17% for MDR and HDR, respectively. Effectiveness of brachytherapy MDR and HDR was similar, whereas serious late complications developed more often after HDR brachytherapy.

Adult↗
PubMed1992

Cervical and vaginal cancer associated with pessary use.

From 1967 to 1990, 96 previously untreated patients with cervicovaginal cancer associated with a history of vaginal pessary use to control uterovaginal prolapse were referred to eight radiation therapy departments in France. Sixty-eight patients had cervical cancer, and 28 had vaginal cancer. The mean interval between pessary insertion and cancer diagnosis was 18 years, with a range of 1 to 41 years. Most patients received radiation therapy and brachytherapy. Few (5%) had Grade 3 treatment side effects. The overall 5-year relative survival rate was 54%; nonsurvival was related to locoregional recurrence. Because almost all tumors occurred at the site of pessary insertion, foreign body chronic inflammation in association with viral infection may be the cause of the tumors.

Aged↗
PubMed1990

[Surgical treatment of cervical and vaginal cancer by means of the synchronized extraperitoneal-vaginal radical operation and the neovagina technic using the peritoneum].

In the period from 1976 to 1986 we operated 350 cases by the technique of combined extraperitoneal-vaginal radical synchronized hysterectomy in cases of uterus and vagina cancer. We analyzed 236 cases and compared them with the control group operated by the technique of Wertheim and modifications. There is a considerable difference in operative and post-operative complications. There are less complications in the examined group of patients operated by the technique of combined synchronized extraperitoneal-vaginal radical operation. We introduced the technique of partial neovagina formation at the place of the resected one, by means of the anterior and posterior plica peritoneum by which we are able to preserve the normal length of the vagina. By the means of this technique we operated 21 patients; out of that 15 were with cancer of the uterus cervix, 6 with vagina cancer, and in 3 of them, a complete vaginectomy was performed, and a complete neovagina made.

Adult↗
PubMed1989

Serum squamous cell carcinoma antigen levels in patients with invasive squamous vulvar and vaginal cancer: a preliminary report.

Pretreatment serum squamous cell carcinoma antigen (SCC) levels were obtained in 12 patients with invasive vulvar and 5 patients with invasive vaginal squamous cancer. Only 4 of 12 (33%) patients with vulvar cancer and 1 of 5 (20%) patients with vaginal cancer, usually those with more advanced disease, had elevated serum SCC levels at the time of diagnosis.

Aged↗
PubMed1998

Cell-mediated immunological responses in cervical and vaginal cancer patients immunized with a lipidated epitope of human papillomavirus type 16 E7.

Human papillomavirus (HPV) infection has been causally associated with cervical cancer. We tested the effectiveness of an HLA-A*0201-restricted, HPV-16 E7 lipopeptide vaccine in eliciting cellular immune responses in vivo in women with refractory cervical cancer. In a nonrandomized Phase I clinical trial, 12 women expressing the HLA-A2 allele with refractory cervical or vaginal cancer were vaccinated with four E786-93 lipopeptide inoculations at 3-week intervals. HLA-A2 subtyping was also performed, and HPV typing was assessed on tumor specimens. Induction of epitope-specific CD8+ T-lymphocyte (CTL) responses was analyzed using peripheral blood leukapheresis specimens obtained before and after vaccination. CTL specificity was measured by IFN-gamma release assay using HLA-A*0201 matched target cells. Clinical responses were assessed by physical examination and radiographic images. All HLA-A*0201 patients were able to mount a cellular immune response to a control peptide. E786-93-specific CTLs were elicited in 4 of 10 evaluable HLA-A*0201 subjects before vaccination, 5 of 7 evaluable HLA-A*0201 patients after two vaccinations, and 2 of 3 evaluable HLA-A*0201 cultures after all four inoculations. Two of three evaluable patients' CTLs converted from unreactive to reactive after administration of all four inoculations. There were no clinical responses or treatment toxicities. The ability to generate specific cellular immune responses is retained in patients with advanced cervical cancer. Vaccination with a lipidated HPV peptide epitope appears capable of safely augmenting CTL reactivity. Although enhancements of cellular immune responses are needed to achieve therapeutic utility in advanced cervical cancer, this approach might prove useful in treating preinvasive disease.

Adult↗
PubMed2002

Primary invasive vaginal cancer. Report of 12 cases.

The aim of this study was to describe the clinical features, methods of treatment and results of treatment among patients with primary invasive cancer. Twelve women in whom primary invasive cancer of the vagina was diagnosed between 1996 and 2001 were studied. The mean age of women with primary invasive vaginal cancer was 70.1 years. Half of the patients had advanced stage carcinoma at the time of the diagnosis and 85% of patients had not had a Pap-smear in the last 15 years. Treatment consisted of radiotherapy or a combination of surgery and radiotherapy. Four patients out of six with advanced stage disease died in 30 months. In conclusion, the present study confirms that early detection of the disease could lead to more successful management and therefore better prognosis.

Adenocarcinoma, Clear Cell↗
PubMed2001

Radiotherapy alone for invasive vaginal cancer: outcome with intracavitary high dose rate brachytherapy versus conventional low dose rate brachytherapy.

PURPOSE: Our aim was to compare the role of remote afterloaded high-dose-rate brachytherapy (HDRB) with traditional low-dose-rate brachytherapy (LDRB) for patients with invasive primary vaginal carcinoma. METHODS: The study group comprised 190 patients with invasive carcinoma of the vagina. The patients were staged according to the International Federation of Gynecology and Obstetrics (FIGO) staging system. Eighty patients were treated with intracavitary high-dose rate iridium 192 brachytherapy with or without external beam therapy. These patients are compared with a historical group of 110 patients treated with intracavitary low-dose-rate radium 226 or cesium 137 brachytherapy with or without external beam therapy. RESULTS: No significant differences were found for stages, tumor grade or location between the two groups. Crude 5-year survival for all patients was 41% in the former LDRB group, 81% in stage I and 43% in stage II. Overall actuarial 3-year survival and disease-specific survival rates for all patients in the HDRB series were 51% and 66%, respectively. Disease-specific 3-year survival attained 83% in stage I and 66% in stage II. There were no significant differences in local and distant recurrences between the treatment modalities. The comparison of treatments with or without external beam radiation and of complications showed no significant differences between the HDRB and LDRB series. CONCLUSION: With HDRB and its advantages of decreased radiation exposure and patient immobilization and precise positioning, treatment results to be obtained are at least similar to traditional LDRB for primary vaginal cancer.

Adult↗
PubMed1995

[Vaginal cancer in a woman with a family history of ovarian cancer].

The proband was referred to familial ovarian cancer surveillance because two of her sisters died of carcinoma of the ovary. Her third sister succumbed of cervical cancer and her brother had acute myeloblastic leukaemia. Her second brother is alive and healthy. None of her parents and their sibs suffered of malignant disease. The offspring of the proband's sibs are young and appear to be normal. During surveillance she developed a stage I vaginal cancer. Following preoperative brachytherapy she underwent a radical hysterectomy and bilateral salpingoophorectomy with pelvic lymphadenectomy, and she is free of disease during 2 years of follow-up. The authors are not aware of any similar case.

Carcinoma, Squamous Cell↗