Radical radiotherapy with a combination of pelvic external-beam and utero-vaginal intra-cavitary brachytherapy is the treatment of choice. The literature is unclear regarding optimum dosimetry and field design. Lower vaginal involvement should prompt consideration of either additional groin node dissection or irradiation. Para-aortic irradiation (extended field) is associated with high morbidity and is of uncertain value.

Overall five-year survival is 40%, and salvage after first relapse is uncommon. Bad prognostic features are primary adenocarcinoma, large tumour bulk, tumour site (lower vaginal lesions fare worse), and posterior vaginal wall involvement. One in five long-term survivors will suffer from serious radiotherapy-related complications.

If the uterus is intact, the tumour involves the upper posterior vagina, and there is small volume disease (highly selected Stage I disease), then a radical hysterectomy, partial vaginectomy, and bilateral pelvic lymphadenectomy may be performed.

Treatment of vaginal cancer should be limited to centres with expertise in gynaecologic oncology.

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