Saijilafu, Gu YJ, Huang AW, Xu CF, Qian LW. Individualized vaginal applicator for stage IIb primary vaginal adenocarcinoma: A case report. World J Clin Oncol 2024; 15(8): 1102-1109 [PMID: 39193155 DOI: 10.5306/wjco.v15.i8.1102]
Corresponding Author of This Article
Li-Wen Qian, MD, PhD, Chief Doctor, Department of Radiation Oncology, Sir Run Run Shaw Hospital, No. 3 East Qingchun Road, Hangzhou 310016, Zhejiang Province, China. 3315015@zju.edu.cn
Research Domain of This Article
Obstetrics & Gynecology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Saijilafu, Hangzhou Lin'an Traditional Chinese Medicine Hospital, Affiliated Hospital, Hangzhou City University, Hangzhou 311300, Zhejiang Province, China
Yan-Jun Gu, Li-Wen Qian, Department of Radiation Oncology, Sir Run Run Shaw Hospital, Hangzhou 310016, Zhejiang Province, China
Ai-Wu Huang, Chang-Fen Xu, Department of the Gynecology and Obstetrics, Hangzhou Lin'an Traditional Chinese Medicine Hospital, Affiliated Hospital, Hangzhou City University, Hangzhou 311300, Zhejiang Province, China
Author contributions: Saijilafu, Huang AW and Xu CF contributed to manuscript writing, editing and revising; Gu YJ contributed to data analysis; Qian LW contributed to data collection, conceptualization, and supervision; All authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li-Wen Qian, MD, PhD, Chief Doctor, Department of Radiation Oncology, Sir Run Run Shaw Hospital, No. 3 East Qingchun Road, Hangzhou 310016, Zhejiang Province, China. 3315015@zju.edu.cn
Received: January 31, 2024 Revised: May 15, 2024 Accepted: June 13, 2024 Published online: August 24, 2024 Processing time: 197 Days and 20.8 Hours
Abstract
BACKGROUND
Primary vaginal cancer is rare and most vaginal tumors are metastatic, often arising from adjacent gynecologic structures. Primary vaginal cancers are also more common among postmenopausal women and most of these are squamous cell carcinomas, with adenocarcinomas being relatively rare. Vaginal bleeding is the most common clinical manifestation of vaginal adenocarcinoma. About 70% of vaginal adenocarcinomas are stage I lesions at the time of diagnosis, for which radical surgery is recommended. However, more advanced vaginal cancers are not amenable to radical surgical treatment and have poor clinical outcomes. Optimal treatments modes are still being explored. Here, we report a rare case of stage IIb primary vaginal adenocarcinoma for which an individually designed vaginal applicator for after-loading radiotherapy was used to achieve good tumor control.
CASE SUMMARY
A 62-year-old woman presented to our clinic after 3 months of abnormal postmenopausal vaginal bleeding. Gynecological examination, computed tomography (CT), and positron emission tomography-CT showed a large mass (about 5 cm) on the anterior vaginal wall. Colposcopy biopsy confirmed adenocarcinoma of vaginal origin. After three cycles of carboplatin plus paclitaxel chemotherapy, the lesion partially shrunk. The patient then received external irradiation of 45 gray (gy) in 25 fractions, which further reduced the vaginal lesion, followed by after-loading radiotherapy of 30 gy in 5 fractions with an individually designed vaginal applicator. Three months later, magnetic resonance imaging showed a slight thickening of the anterior vaginal wall.
CONCLUSION
Primary vaginal adenocarcinoma is rare, and prognosis is poor in most vaginal cancers of locally advanced stages, which cannot be treated with radical surgery. Better tumor control can be achieved with an individualized vaginal applicator that allows administration of a higher radical dose to the tumor area while protecting normal tissues.
Core Tip: We report a rare case of stage IIb primary vaginal adenocarcinoma. After three cycles of induction chemotherapy and intensity-modulated external radiation therapy, an individually designed vaginal applicator for after-loading radiotherapy was used to achieve good tumor control.
