Treatment of Stage I Vaginal Cancer (T1N0M0) in Adults: Small Lesion Up to 2 cm
This protocol addresses adult patients with stage I vaginal cancer (T1N0M0) where the lesion is small — maximum 2 cm — and is not in close relation to the urethra or rectum. This specific anatomical and staging profile opens the door to curative-intent treatment with several viable approaches.
Clinical Scenario
The defining features of this population are early-stage disease (T1N0M0), lesion size up to 2 cm, and the absence of proximity to the urethra or rectum. This anatomical freedom is essential: surgical resection requires that microscopically clear margins can be obtained without requiring additional urological or gastrointestinal resection — a condition only met when the tumour is not close to those structures.
Treatment Goal
The primary aim of curative treatment is complete tumour removal with microscopically clear (free) resection margins, regardless of the modality chosen.
Treatment Approach — Partial Overview
Curative treatment is individualised based on tumour operability, location, and patient preference. Options span surgical resection, primary chemoradiotherapy combining external beam radiotherapy with brachytherapy, and — in a carefully selected subset — brachytherapy alone. Which modality applies, and how each is structured, is set out in the full protocol.
References
DOI: 10.1016/j.radonc.2023.109662
As complete tumour removal with free margins is the goal of any curative surgery for vaginal cancer, the surgical route should be pursued only for small size lesions (maximum size up to 2 cm) stage I (T1N0M0) disease, that are not close to urethra or rectum, so that they would require additional urological and/ or GI resections.
The surgical treatment consists of (partial) colpectomy and lymph node assessment depending on the location of the primary lesion [IV, A].
Primary chemoradiotherapy includes the combination of external beam radiotherapy (EBRT), brachytherapy and cisplatin-based chemotherapy as the recommended regimen.
In selected patients with tumours confined to the vaginal wall and a maximum size up to 2 cm and limited thickness (that can be appropriately covered by intracavitary technique alone, i.e. < 7 mm thick), brachytherapy alone can be considered, after comprehensive surgical lymph node staging.
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