Intensity modulated radiation therapy for squamous cell carcinoma of the vulva: Treatment technique and outcomes

Abstract

ObjectiveThe objective of this study was to present the treatment technique and evaluate clinical outcomes after intensity modulated radiation therapy (IMRT) for vulvar cancer.Methods and materialsThis retrospective study included 39 patients with squamous cell carcinoma of the vulva treated with IMRT from 2005 to 2015. There were 21 patients treated with postoperative IMRT, 13 with definitive IMRT, and 5 with preoperative IMRT. Tumor staging was Federation of Gynecology and Obstetrics stage I in 6, stage II in 7, stage III in 19, and stage IV in 7 patients. Concurrent chemotherapy was administered to 14 patients. Brachytherapy was delivered in 8 patients.ResultsThe median follow-up was 34 months (range, 3.3-71). Median IMRT dose to patients receiving pre- or postoperative IMRT was 5040 cGy (range, 5040-6080). Median combined IMRT and brachytherapy dose to gross tumor was 7000 cGy (range, 5040-7520) in those treated with definitive RT. The 3-year locoregional control (LRC) and overall survival for those receiving postoperative RT were 89% and 67%, respectively. The 3-year LRC and overall survival for those receiving definitive IMRT were 42% and 49%, respectively. In patients receiving definitive or neoadjuvant IMRT, 69% had complete clinical response and 44% had complete pathologic response. The actuarial 3-year inguinal recurrence rate was 7%. There were no acute grade 3-4 hematological, gastrointestinal, or genitourinary toxicities. There were no late grade 3-4 gastrointestinal or genitourinary toxicities.ConclusionsIMRT for vulvar cancer is associated with high rates of LRC in the postoperative setting and limited radiation-related toxicity. Durable LRC of disease after definitive IMRT remains challenging, and several refinements to our treatment technique are suggested.

Phase II study of definitive chemoradiation for locally advanced squamous cell cancer of the vulva: An efficacy study

“…Gastrointestinal toxicity (≥ grade 3) was present in 8% of patients. Previous studies reported on acute GI grade 2 toxicity in about 30% (grade 3 was not reported, not mentioned or not observed) [27,30]. We reported grade 3 GI toxicity in 4 patients (8%).…”

“…Another difference can be the type of chemotherapy. In most studies chemotherapy is cisplatinbased [28,30], cisplatin-5FU-based [9,29] or 5FU-based chemotherapy [27]. Our study is the first to report on oral-5FU (capecitabine) based chemotherapy in combination with radiotherapy.…”

Dose escalated simultaneous integrated boost of gross nodal disease in gynecologic cancers: a multi-institutional retrospective analysis and review of the literature

“…In our six patients with vulvar cancer, we achieved 100% nodal control without resection, but as with any vulvar radiation, there was significant acute G≥3 dermatologic and late urinary toxicities. A minimum boost dose of 60–70 Gy (type unspecified) has been recommended for GND [ 12 , 41 , 42 ].…”

Role of Locoregional Treatment in Vulvar Cancer With Pelvic Lymph Node Metastases: Time to Reconsider FIGO Staging?

“…23 The role for definitive RT, generally with chemotherapy, in the management of unresectable vulvar cancer is well documented from multiple prospective studies, 15,24 with contemporary series showing feasibility of using advanced techniques with good oncologic outcomes in well-selected patients. [25][26][27] Standard limitations of retrospective analysis and database studies apply. We attempted to mitigate as much bias as possible by adjusting for measured confounders through MVA.…”