Abstract YO19
Case summary
Introduction: Vulvar Cancer is a rare gynecologic malignancy making up 5% of all cancers of the female genital tract. We report a case of a metastatic Vulvar Squamous Cell Carcinoma in a postmenopausal female. To our knowledge, there were only 3 reported cases at Philippine General Hospital from July 16, 1945 to June 16, 1950. In Mindanao, this is the second documented case in Southern Philippines Medical Center.
Case Presentation: A 70 year old female presented with an initially painless right vulvar lesion which progressed to a tender mass associated with purulent discharge. Whole abdominal CT scan revealed a fungating, polypoid enhancing soft tissue mass protruding from the introitus, extending superiorly to the lower vaginal region. She underwent EBRT to the whole pelvis and bilateral inguinal regions (5040cGy) x 28 Fractions with noted partial response. However on reassessment, pulmonary metastasis was noted. She underwent Image-guided Brachytherapy, to complete 3 sessions and for sequential chemotherapy with Paclitaxel + Carboplatin thereafter. The patient is ongoing therapy as of this writing.
Learning Points: Treatment options for metastatic Vulvar Cancer are limited and has no standard of care. Current recommendations are mostly extrapolated from Cervical Cancer which includes concurrent chemoradiotherapy, and systemic chemotherapy. HPV testing or molecular testing is indicated to classify HPV -association. For HPV independent carcinoma, p53 is recommended. Vulvar cancer cells are known to overexpress PDL-1 and immunotherapy may be an option in patients who progress after standard chemotherapy. Independent predictors of survival include the presence and number of involved lymph nodes and primary tumor size.
Conclusion: EBRT showed partial response in patients with unresectable Vulvar Carcinoma and Brachytherapy with sequential chemotherapy (Caboplatin + paclitaxel) can be an option for postmenopausal and elderly patient after disease progression. Multimodality treatment for metastatic vulvar cancer may achieve a favorable outcome in patients.
Keywords: Vulva, Squamous cell, EBRT, Chemotherapy, Brachytherapy