Intensity-modulated radiotherapy for the treatment of vulvar carcinoma: A comparative dosimetric study with early clinical outcome

Beriwal, Sushil; Heron, Dwight E.; Kim, Hayeon; King, Gwendolyn C.; Shogan, Jeffrey; Bahri, Sanjeev; Gerszten, Kristina; Lee, Joe; Kelley, Joseph L.; Edwards, Robert P.

doi:10.1016/j.ijrobp.2005.11.007

Cited by 84 publications

(33 citation statements)

References 29 publications

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“…Intensity modulated RT (IMRT) improves the avoidance of critical structures, while maintaining adequate tumor volume coverage (7). This benefit in the treatment of vulvar carcinoma, especially in difficult cases, has been reported previously (8–10). As in anal cancer, IMRT has rapidly become a standard option in vulvar cancer and is now used in NRG Oncology protocol (Gynecologic Oncology Group [GOG] 0279) (11).…”

Section: Introductionsupporting

confidence: 76%

Consensus Recommendations for Radiation Therapy Contouring and Treatment of Vulvar Carcinoma

Gaffney

King

Viswanathan

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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Purpose The purpose of this study was to develop a radiation therapy (RT) contouring atlas and recommendations for women with postoperative and locally advanced vulvar carcinoma. Methods and Materials An international committee of 35 expert gynecologic radiation oncologists completed a survey of the treatment of vulvar carcinoma. An initial set of recommendations for contouring was discussed and generated by consensus. Two cases, 1 locally advanced and 1 postoperative, were contoured by 14 physicians. Contours were compared and analyzed using an expectation-maximization algorithm for simultaneous truth and performance level estimation (STAPLE), and a 95% confidence interval contour was developed. The level of agreement among contours was assessed using a kappa statistic. STAPLE contours underwent full committee editing to generate the final atlas consensus contours. Results Analysis of the 14 contours showed substantial agreement, with kappa statistics of 0.69 and 0.64 for cases 1 and 2, respectively. There was high specificity for both cases (≥99%) and only moderate sensitivity of 71.3% and 64.9% for cases 1 and 2, respectively. Expert review and discussion generated consensus recommendations for contouring target volumes and treatment for postoperative and locally advanced vulvar cancer. Conclusions These consensus recommendations for contouring and treatment of vulvar cancer identified areas of complexity and controversy. Given the lack of clinical research evidence in vulvar cancer radiation therapy, the committee advocates a conservative and consistent approach using standardized recommendations.

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Section: Introductionsupporting

confidence: 76%

Consensus Recommendations for Radiation Therapy Contouring and Treatment of Vulvar Carcinoma

Gaffney

King

Viswanathan

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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“…GOG 205, a phase 2 trial of neoadjuvant 3D conformal chemoradiation with weekly cisplatin, had a cCR rate of 64% and a pCR rate of 50% 23 . IMRT in the neoadjuvant setting has been extensively investigated by Beriwal et al, who treated patients with twice-daily IMRT to a median dose of 4640 cGy concurrent with cisplatin/5-fluorouracil 3, 9, 10. They observed a pCR rate of 48.5% and 3-year recurrence free survival of 65.9%.…”

Section: Discussionmentioning

confidence: 99%

“…Radiation has traditionally been administered in the supine, frog-legged position using opposed anteroposterior-posteroanterior field setup in addition to supplemental dose to the vulva or inguinal nodes as needed. Beriwal et al 3 and Bloemers et al 4 have shown in dosimetric studies that intensity modulated RT (IMRT) may be advantageous in the treatment of vulvar cancer because it may reduce dose to small bowel, rectum, bladder, and femurs.…”

Section: Introductionmentioning

confidence: 99%

“…IMRT may reduce dose to pelvic bones, which could in turn reduce hematologic toxicity for patients receiving concurrent chemotherapy 6 . Beriwal et al have published extensively on the use of preoperative IMRT with concurrent chemotherapy for vulvar cancer, which resulted in a complete pathologic response rate (pCR) of 48.5% and limited treated-related toxicity 3, 9, 10. There is additional interest in the use of IMRT for vulva cancer after the publication of consensus contouring guidelines 11 and National Comprehensive Cancer Network 12 clinical guidelines allowing IMRT as a therapeutic option.…”

Section: Introductionmentioning

confidence: 99%

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

Rao

Chundury

Schwarz

et al. 2017

Advances in Radiation Oncology

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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.

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“…Several dosimetric studies have already shown the potential advantage of adjuvant IMRT in decreasing the dose to the small bowel in cervical and endometrial cancer. 8,9 In 2006, Beriwal et al 12 published a comparative dosimetric study of 15 patients treated with IMRT for vulvar cancer with early clinical outcome. A median dose of 46 Gy in the preoperative and 50.4 Gy in the postoperative group was used for these dosimetric studies.…”

Section: Discussionmentioning

confidence: 99%

A dosimetric evaluation of dose escalation for the radical treatment of locally advanced vulvar cancer by intensity-modulated radiation therapy

et al. 2012

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Intensity-modulated radiotherapy for the treatment of vulvar carcinoma: A comparative dosimetric study with early clinical outcome

Cited by 84 publications

References 29 publications

Consensus Recommendations for Radiation Therapy Contouring and Treatment of Vulvar Carcinoma

Consensus Recommendations for Radiation Therapy Contouring and Treatment of Vulvar Carcinoma

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

A dosimetric evaluation of dose escalation for the radical treatment of locally advanced vulvar cancer by intensity-modulated radiation therapy

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