Stage I Vaginal Cancer in Adults: What to Do When Surgical Resection Did Not Achieve Clear Margins

Clinical Scenario

This protocol applies to adult patients with stage I vaginal cancer (T1N0M0) — a small primary lesion of up to 2 cm in maximum size, not in close proximity to the urethra or rectum — who have already undergone initial curative surgical treatment.

Why Escalation Is Required

Initial curative treatment — surgical resection (colpectomy with lymph node assessment) — aimed to achieve complete tumour removal with microscopically clear (free) resection margins. This protocol addresses the situation where that goal was not met: specifically, when resection margins are tumour-positive, or when lymph node metastasis has been confirmed on histology.

Next-Step Treatment Approach

When initial surgery leaves positive margins or reveals nodal involvement, adjuvant radiotherapy is indicated as the next intervention. In certain histologically confirmed circumstances, the addition of a cisplatin-based chemotherapy agent is also recommended or may be considered. The complete evidence-based protocol — including all indications, options, and sequencing — is available via the link below.

Instant Access to Structured Evidence-Based Regimens

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.

Adjuvant radiotherapy is recommended in patients with tumour positive resection margins, or lymph node metastasis [IV, A].

The addition of concomitant cisplatin-based chemotherapy is recommended in case of histologically confirmed lymph node metastasis [IV, A]. This addition can be considered in case of positive surgical margins [IV, B].

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