Radiation Treatment of Primary Carcinoma of the Vagina: Patterns of failures after definitive therapy

Abstract

Patterns of failures after definitive radiation therapy were analyzed in 88 patients with primary carcinoma of the vagina treated between 1957 and 1975. The majority of the local failures in early stages of the disease (I, I1 and a few 111) were due to inadequate treatment either by external beam therapy or brachytherapy. In some cases the inadequate treatments were unavoidable (previous radiation treatment) and in a few they were due to poor brachytherapy technique. Distant failures are still a problem and need to be given further attention.

Radiotherapy alone for invasive vaginal cancer: outcome with intracavitary high dose rate brachytherapy versus conventional low dose rate brachytherapy

“…In our former LDRB group, serious complications were reported in 5.4% of patients (3). This is consistent with other reports in the literature (11, 12, 16, 20–22, 24). In the HDRB series, grade‐4 side effects were found in three out of 80 patients (3.7%).…”

“…In stages II and III, there was a trend toward a better tumor control with combined external irradiation and brachytherapy than with the latter alone although the difference was not significant (6). This is in keeping with the results of other authors (12, 20–22) but it should be stressed that only small‐volume, superficial tumors should be treated with brachytherapy alone.…”

Management of Vaginal Cancer

“…Large, institutional series of definitive radiotherapy for early-stage vaginal cancer have reported 5-year causespecific survival rates of 40%-92% for stage I disease and 35%-78% for stage II disease (see Appendix 1) [23][24][25][26][27][28][29][30][31]. In patients with superficial stage I lesions, brachytherapy alone has been used with 5-year survival rates of 53%-100% [24,27,28,31,32].…”

“…Pelvic failure rates following brachytherapy alone range from 14% to 33% [24,27]. Although several studies have shown no difference in outcome from adding external beam radiation therapy (EBRT) to brachytherapy for stage I disease [27,31,32], others have advocated for using that combination in patients with higher grade and infiltrative lesions, given the increased risk of local-regional failure [29,33,34]. In stage II disease, the combination of EBRT and brachytherapy has been associated with improved pelvic control and survival [27].…”

“…Advanced-stage vaginal cancer is primarily managed with definitive radiation therapy with cause-specific survival rates that range from 23%-59% for stage III disease and from 0%-25% for stage IV disease (see Appendix 1) [23][24][25][26][27][28][29][30][31]. Corresponding pelvic control rates are 62%-71% and 12%-30%, respectively.…”