PRIMARY CARCINOMA OF THE VAGINA

31 cases of primary carcinoma of the vagina treated from 1970 through 1990 at our institution are analysed retrospectively. 6 (19%) had pervious hysterectomies for benign disorders. Median age was 60, range 14-80 years. Distribution to stages at the time of diagnosis was as follows: 1 patient (pt) (3%) stage I, 6 pts (19%) stage II, 13 pts (42%) stage III, 9 pts (19%) stage IVa, 1 pt (3%) stage IVb, 4 pts (13%) not recorded. Histopathological diagnosis were as follows: 25 (81%) epidermoid ca., 2 (6%) adenocarcinoma, 1 (3%) mesenchimal sarcoma, 3 (10%) subtype unrecorded carcinoma. Every patient had biopsy. 11 pts , had external only, 5 had intracavitary only and 15 had external and intracavity combined irradiation. External irradiation portal covered the pelvis, vagina in full lenght, and the bilateral inguinal regions. Intravaginal cylinder was used for high dose rate, remote control after-loading intracavitary irradiation. By external irradiation 50 Gy was delivered to the mid-plane of the pelvis and 50-65 Gy to 3 cm below the skin of inguinal region. By brachytherapy 30 Gy mucosal dose was given in 3 fractions, 1 fraction/week 3 year overall survivals were as follows: 23% for the whole series of carcinoma; 17% in stage II, 27% in III, 0% in stage IVa. 3 year survival by treatment modality was, 0% with external irradiation only, 20% with intracavitary irradiation only, and 42% with external and intravavitary combined irradiation (P=0.06). Radiotherapy is an effective treatment in carcinoma of the vagina, brachytherapy is an important component of this treatment.