Patricia J. Eifel

The radiation oncologist plays a central role in the treatment of most invasive vaginal cancers because definitive surgical resection usually cannot be achieved without loss of normal bowel or bladder function. However, primary vaginal cancers pose particularly difficult challenges for radiation oncologists because they are very rare, because highly specialized techniques are required to achieve the best outcomes, and because the proximity of critical structures causes the window for complication-free cure to be narrow. Widely differing techniques may be used depending on the initial location, and distribution of disease and on the response to initial external beam irradiation. In most cases, intracavitary or interstitial brachytherapy provides an ideal way of maximizing the ratio between the doses to tumor vs. normal tissues. However, highly conformal external beam techniques are also extremely useful in selected cases. Some of the factors that drive treatment selection will be discussed. Fortunately, with careful, skilled management most patients with primary vaginal cancer can be cured of their disease.

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