Radiation Therapy for Vulvar Cancer

Radiation therapy uses high-energy rays (such as gamma rays or x-rays) and particles (such as electrons, protons, or neutrons) to kill cancer cells. When used to treat vulvar cancer, a large machine sends the radiation into the body in a procedure that's a lot like getting an x-ray. This is called external beam radiation therapy or ERBT.

When is radiation used?

Radiation is most often used along with chemotherapy when treating vulvar cancer. You might hear this called chemoradiation.

It can be used to treat more advanced cancers. The goal is to shrink the tumor so it can be removed with surgery. Sometimes this allows the doctor to remove the cancer while causing less damage to healthy tissues.

Radiation can also be used after surgery to kill any cancer cells that might have been left behind.

Radiation alone may be used to treat lymph nodes in the groin and pelvis.

It also may be used with or without chemo as the main treatment for women who are not well enough to have surgery.

Types of external beam radiation therapy

There are ways to give EBRT so that the radiation is focused more precisely on the tumor. This let doctors give higher doses of radiation to the tumor while reducing the radiation exposure to nearby healthy tissues.

Three-dimensional conformal radiation therapy (3D-CRT)

3D-CRT uses special computers to precisely map the location of the tumor. Radiation beams are then shaped and aimed at it from several directions, which makes it less likely to damage normal tissues.

Intensity modulated radiation therapy (IMRT)

IMRT is an advanced form of 3D therapy. It uses a computer-driven machine that moves around the patient as it delivers radiation. Along with shaping the beams and aiming them at the tumor from several angles, the intensity (strength) of the beams can be adjusted to limit the doses reaching nearby normal tissues, like the bones, bowel, rectum, and bladder. This lets doctors deliver an even higher dose to the cancer.

Side effects of radiation therapy

Common short-term side effects of radiation therapy to the pelvis include:

• Tiredness can become severe a few weeks after treatment begins. Diarrhea, nausea, and vomiting from radiation can usually be controlled with medicines.
• Skin changes are common in the area the radiation passes through to reach the cancer. This can range from mild, temporary redness to blistering and permanent discoloration.
• Radiation can cause the vulvar area to become sensitive and sore. The skin may release fluid, which can lead to infection, so the area exposed to radiation must be carefully cleaned and protected.
• Radiation can also lead to low blood counts, causing anemia (low red blood cells) and neutropenia (low white blood cells). Low red blood cell counts can lead to feeling tired and short of breath. Low white blood cells can increase the risk of serious infection. The blood counts usually return to normal over time after radiation is stopped.
• Women who receive radiation to the inguinal (groin) area after a lymph node dissection may have problems with the surgical wound site. It may open up or have trouble healing.
• Radiation to the lymph nodes can lead to poor fluid drainage from the legs. The fluid can build up and lead to severe leg swelling that doesn’t go down at night. This is called lymphedema. Information about lymphedema and how to manage it can be found in Lymphedema.

These side effects tend to be worse when chemotherapy is given with radiation.If you have side effects from radiation, tell your cancer care team. There are often ways to relieve them.