Definitive treatment of primary vaginal cancer with radiotherapy: multi-institutional retrospective study of the Korean Radiation Oncology Group (KROG 12-09)

Abstract

ObjectiveTo assess the outcome of the treatment of primary vaginal cancer using definitive radiotherapy (RT) and to evaluate the prognostic factors of survival.MethodsThe medical records of nine institutions were retrospectively reviewed to find the patients with vaginal cancer treated with definitive RT with or without chemotherapy. A total of 138 patients met the inclusion criteria. None had undergone curative excision.ResultsThe median follow-up time of the survivors was 77.6 months and the median survival time was 46.9 months. The 5-year overall survival, cancer-specific survival (CSS), and progression-free survival (PFS) rates were 68%, 80%, and 68.7%, respectively. In the survival analysis, the multivariate analysis showed that a lower the International Federation of Gynecology and Obstetrics (FIGO) stage and prior hysterectomy were favorable prognostic factors of CSS, and a lower FIGO stage and diagnosed prior to year 2000 were favorable prognostic factors of PFS. In the subgroup analysis of the patients with available human papillomavirus (HPV) results (n=27), no statistically significant relationship between the HPV status and recurrence or survival was found. Grade 3 or 4 acute and late toxicity were present in 16 and 9 patients, respectively. The FIGO stage and the tumor size were predictors of severe late toxicity.ConclusionThe data clearly showed that a higher FIGO stage was correlated with a worse survival outcome and higher severe late toxicity. Therefore, precise RT and careful observation are crucial in advanced vaginal cancer. In this study, the HPV status was not related to the survival outcome, but its further investigation is needed.

Definitive Radiotherapy in Invasive Vaginal Carcinoma: A Systematic Review

“…The correlation of age with outcomes was contradictory. Greenwalt et al and Laliscia et al reported improved OS and PFS in younger patients (patients aged <64 and <70 years, respectively) whereas Chang et al reported an improved OS in patients over 60 years of age .…”

“…In fact, only five of the ten studies in which some patients received C‐CT reported the specific results in this subgroup of patients or presented a comparison with RT alone. In four studies, C‐CT was based on weekly cisplatin in most patients , and in another study the chemotherapy drugs were not specified . Only one study reported toxicity in patients undergoing C‐CT (grade ≥3 acute, 20%; late, 20%) .…”

“…From a total of 199 retrieved studies, 13 articles reporting data on 793 patients (median, 45; range, 26-138) met our inclusion criteria [7][8][9][10][11][12][13][14][15][16][17][18][19], as shown in Figure 1. The patients included in the analyzed studies were treated between 1959 and 2014, and the median follow-up for the whole population ranged from 27.6 to 90.0 months.…”

“…Different treatment combinations of radiation therapy were used (EBRT + BT and/or EBRT alone and/or BT alone); a majority of the patients were treated with a combination of EBRT and BT (74.2%) [7][8][9][10][11][12][13][14][15][16][17][18][19]. In ten studies, a minority of patients (20.9%) received a combination of RT and chemotherapy [7,8,10,[12][13][14][16][17][18][19]. In four studies, RT was combined with up-front surgery in 14.7% of patients [10,12,13,19], and in one study, hyperthermia was administered to 15.9% of the patients [7].…”

Sentinel lymphonodectomy in early vaginal cancer using combined near infrared fluorescence from indocyanine green and technetium-99m nanocolloid – a first case report

“…The therapeutic approach in vaginal cancer depends on the tumor stage and localization and may include a local radical excision, partial or total colpectomy with paracolpic tissue +/-radical hysterectomy or radiochemotherapy and / or vaginal brachytherapy [1][2][3][4]. The most important prognostic parameter in vaginal cancer is the lymphatic status of the draining lymph nodes [5][6][7].…”