Western Regional Blog – BC, YK, AB, NWT and Nunavut
“The majority of primary vaginal cancers are squamous cell carcinomas, which are frequently associated with human papillomavirus infection.[2,3] Given the rarity of this disease, prospective trials of patients with vaginal cancer have not been feasible, and evidence for treatment relies on single institutional reports of clinical outcomes spanning several decades. Due to these limitations, management guidelines for vaginal cancer are currently extrapolated from reported clinical experience and prospective studies of cervical and anal cancer, given the similarities in disease etiology and the desire for organ preservation. “
By Larissa J. Lee, MD, Anuja Jhingran, MD, Elizabeth Kidd, MD, Higinia Rosa Cardenes, MD, PhD, Mohamed A. Elshaikh, MD, Beth Erickson, MD, Nina A. Mayr, MD, David Moore, MD, Ajmel A. Puthawala, MD, Gautam G. Rao, MD, William Small, Jr, MD, Mahesh A. Varia, MD, Andrew O. Wahl, MD, Aaron H. Wolfson, MD, Catheryn M. Yashar, MD, William Yuh, MD, and David K. Gaffney, MD, PhD
ABSTRACT: Due to its rarity, treatment guidelines for vaginal cancer are extrapolated from institutional reports and prospective studies of cervical and anal cancer. An expert panel was convened to reach consensus on the selection of imaging and therapeutic modalities. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) used by the panel to rate the appropriateness of imaging and treatment procedures. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. Four variants were developed to represent clinical scenarios in vaginal cancer management. Group members reached consensus on the appropriateness of the pretreatment evaluation and therapeutic interventions. This article represents the consensus opinion of an expert panel and may be used to inform clinical recommendations in vaginal cancer management.