Outcome of Definitive Treatments in Primary Vaginal Cancer Patients: An Institutional Review (original) (raw)
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2357: Concurrent Chemo-Radiation for the Treatment of Primary Vaginal Cancer
2006
To evaluate the role of concurrent chemo-radiotherapy in the curative treatment of primary vaginal cancer. Materials/Methods: A retrospective chart review was performed on all primary vaginal cancer patients treated at the Ottawa Hospital Regional Cancer Centre with curative intent using concurrent chemotherapy and radiotherapy, between 1999 and 2004. Disease-free and overall survival rates were analyzed using the Kaplan-Meier method. Results: Twelve patients were identified as being treated with curative intent using concurrent chemotherapy and radiation therapy. The median age at diagnosis was 56 years (range 34-69 years) and the median follow-up was 43 months (range 11-75 months). Ten (83%) were diagnosed with squamous cell carcinoma and 2 (17%) with adenocarcinoma. The distribution according to stage was as follows: 5 (42%) stage II, 5 (42%) stage III and 2 (16%) stage IVA. All patients received pelvic external beam radiotherapy concurrently with weekly intravenous cis-platinum chemotherapy followed by brachytherapy. The median dose of external beam radiotherapy was 4500cGy given in 25 fractions over 5 weeks. Ten patients received interstitial brachytherapy and 2 patients received intracavitary brachytherapy, with the median dose being 3000cGy. The weekly dose of the intravenous cis-platinum chemotherapy was 40mg/m2. At the time of analysis, 3 patients had developed a recurrence and all three patients had died. The 5-year overall survival, disease-specific survival and loco-regional control rates were 73%, 80%, and 92%, respectively. Although acute grade 1 and 2 toxicities were noted among many of the patients, grade 3 toxicity requiring hospitalization and/or surgery occurred in only 2 patients (17%). None of the patients had a life threatening or fatal toxicity. Conclusions: Chemo-radiotherapy is highly effective for the treatment of primary vaginal cancer patients and has an acceptable toxicity profile.
Twenty-year review of radiotherapy for vaginal cancer: An institutional experience
Gynecologic Oncology, 2008
To evaluate clinical outcome, prognostic factors and chronic morbidity with radiotherapy for vaginal cancer treatment. 68 patients with vaginal cancer treated by radical or adjuvant radiotherapy (RT) were selected. Five with rare subtypes of histopathology and 8 with adenocarcinoma were excluded from this study. 76.4% of the remainder had early-stage diseases (stage I: 14, II: 28, III: 9, and IV: 4). The patients in the years from which they were treated were almost evenly distributed (1st 5 years: 13, 2nd: 14, 3rd: 16, and 4th: 12). There were four treatment groups: external beam radiotherapy (EBRT) alone (n=18), brachytherapy (BT) alone (n=4), EBRT and BT (n=30), and surgery plus RT (n=3). Median follow-up was 50.3 months ranging from 3 to 213 months. 5-year overall survival (OS) was 55.6%, disease-specific survival (DSS) was 77.3%, disease-free survival was 74.2%, and local control was 87.7%. Independent prognostic factors for DSS and OS were tumor stage, site and size (p<0.05). Late radiation toxicity was minimal in the bladder (4.6%) and bowel (4.6%). Vaginal morbidity was observed in 35 patients (63.6%). It was lowest in the BT alone (0%), and highest in the EBRT and BT group (82.1%), especially for those received more than 70 Gy (p=0.05, Odds ratio=4.64, 95% confidence interval: 1.01-21.65). This retrospective review suggested that tumor stage, site, and size were important prognostic factors in patients with vaginal cancer. Higher radiation dose was associated with more frequent vaginal toxicity.
Definitive Radiotherapy in Invasive Vaginal Carcinoma: A Systematic Review
The oncologist, 2018
This study systematically reviews the recent literature on the role of definitive radiotherapy (RT) in the management of vaginal cancer (VC) and presents comprehensive data on clinical outcomes and toxicity. The authors performed a literature search using PubMed (2007-2016) to identify all prospective and retrospective studies that have been published on RT in invasive VC. Of the 199 identified studies, 13 met the inclusion criteria. All studies had a retrospective design. Overall, 793 patients (median, 45; range, 26-138) were included. A high heterogeneity was found across studies in terms of RT techniques, assessment criteria, and reported outcomes. The majority of the patients were treated with a combination of external beam RT and brachytherapy (74.2%). Acute and late grade ≥3 toxicity rates ranged from 0.0% to 24.4% (median, 8.7%) and from 0.0% to 22.5% (median, 12.8%), respectively. The 5-year local control rates ranged between 39% and 79%. The 5-year overall survival ranged b...
Definitive radiotherapy for carcinoma of the vagina: Outcome and prognostic factors
International Journal of Radiation Oncology*Biology*Physics, 1996
Primary carcinoma of the vagina is an uncommon tumor. Because of the long-stancti-ng interest in thts disease at our institution a substantial number of patients with this disease has been accumulated, and this retrospective review was performed to define disease outcome, to delineate significant prognostic factors, and to provide treatment guidelines. Methods and Materials: This was a retrospective review of 301 patients with vaginal carcinoma (271 with squamous cell and 30 with adenocarcinoma) who received defmltlve radiotherapy between 1953 and 1991. Prognostic factors for outcome (local control, pelvic control, metastatic relapse, survival, and complications) were evaluated using univariate and multivariate techniques. Results: Patients disease was staged using the International Federation of Gynecology and Obstetrics m) system, and stages were distributed as follows: 0,37 (12%); I, 65 (22%); II, 122 (40%); III, 60 (20%) ; and, IVA, 17 (6%). Treatment varied according to stage, with brachytherapy predominating for early disease but external beam playing a prominent role for more advanced disease. Patients with in situ disease received brachytherapy alone or transvaginal orthovoltage irradiation. For Stage I, brachytherapy alone was used io 25, external beam and brachytherapy in 38, and transvaginal alone in 2. For Stage II, brachytberapy alone was used in 20, external and brachytherapy in 66, and external irradiation alone in 36. For Stage ID, external and brachytherapy was used in 15, and external alone in 45. Two patients with Stage IVA received brachytherapy alone, 10 received a combination of external and brachytherapy, and 6 received external irradiation alone. Total doses ranged from 10 to 154 Gy (mean 74.7 Gy, median 70.0 Gy), but only 18 (6%) received less than 55 Gy. At a median follow-up of 13 years, the 5, lo-, 15, 20~ and 25-year survival rates were 60%, 49%, 38%, 29%, and 23%, respectively. Beyond 5 years the survival rates relative to those for age-matched females in the general population were between 50 and 65%. Actuarial local recurrence rates were 23%, 26%, and 26% at 5, 10, and 15 years. Actuarial pelvic relapse rates were 26%, 30%, and 31% at 5, 10, and 15 years, and metastatic rates at those times were 15%, 18%, and 18%. Adenocarcinoma (nonclear cell) was a significantly worse disease than squamous cell carcinoma. The major determinants of local control for squamous carcinoma were tumor bulk (spa&W by size in centhneters, or by FIG0 stage), tumor site (upper lesions faring better than others), and tumor circumferential location (lesions involving the posterior wall faring worse). Tumor bulk was an important determinant of metastatic relapse, but failure to achieve local control was also an independently sign&ant determinant of metastases. Salvage after first relapse was uncommon and the survival rate at 5 years after relapse was only 12%. Serious complications occurred in 39 patients with an actuarial incidence of 19% at 26) years. Conduslon: Vaginal carcinoma poses a formidable therapeutic challenge. The d&ease is heterogen&ms with respect to its prognostic factors. Nonclear cell adenocarcinoma has an extremely poor prognosis and should be distinguished from squamous carcinoma. Both external beam and brachytherapy play crucial roles in management and most patients with disease beyond in situ should receive a significant component of external irradiation prior to brachytherapy.
Factors affecting long-term outcome of irradiation in carcinoma of the vagina
International Journal of Radiation Oncology*Biology*Physics, 1999
Objective: This report evaluates prognostic and technical factors affecting outcome of patients with primary carcinoma of the vagina treated with definitive radiation therapy. Methods and Materials: A retrospective analysis was performed on records of 212 patients with histologically confirmed carcinoma of the vagina treated with irradiation. Results: Tumor stage was the most significant prognostic factor; actuarial 10-year disease-free survival was 94% for Stage 0 (20 patients), 80% for Stage I (59 patients), 55% for Stage IIA (63 patients), 35% for Stage IIB (34 patients), 38% for Stage III (20 patients), and 0% for Stage IV (15 patients). All in situ lesions except one were controlled with intracavitary therapy. Of the patients with Stage I disease, 86% showed no evidence of vaginal or pelvic recurrence; most of them received interstitial or intracavitary therapy or both, and the addition of external-beam irradiation did not significantly increase survival or tumor control. In Stage IIA (paravaginal extension) and IIB (parametrial involvement) 66% and 56% of the tumors, respectively, were controlled with a combination of brachytherapy and external-beam irradiation; 13 of 20 (65%) Stage III tumors were controlled in the pelvis. Four patients with Stage IV disease (27%) had no recurrence in the pelvis. The total incidence of distant metastases was 13% in Stage I, 30% in Stage IIA, 52% in Stage IIB, 50% in Stage III, and 47% in Stage IV. The dose of irradiation delivered to the primary tumor or the parametrial extension was of relative importance in achieving successful results. In patients with Stage I disease, brachytherapy alone achieved the same local tumor control (80 -100%) as in patients receiving external pelvic irradiation (78 -100%) as well. In Stage II and III there was a trend toward better tumor control (57-80%) with combined external irradiation and brachytherapy than with the latter alone (33-50%) (p ؍ 0.42). The incidence of grade 2-3 complications (12%) correlated with the stage of the tumor and type of treatment given. Conclusion: Radiation therapy is an effective treatment for patients with vaginal carcinoma, particularly Stage I. More effective irradiation techniques, including optimization of dose distribution combining external irradiation and interstitial brachytherapy in tumors beyond Stage I, are necessary to enhance locoregional tumor control. The high incidence of distant metastases emphasizes the need for earlier diagnosis and effective systemic cytotoxic agents to improve survival in these patients.
Primary carcinoma of the vagina: Tata Memorial Hospital experience
International Journal of Radiation Oncology*Biology*Physics, 2000
Purpose: Carcinoma of the vagina is a rare gynecological malignancy comprising approximately 2% of all the gynecological malignancies. We have analyzed the treatment outcome of the patients treated at the Tata Memorial Hospital from January 1984 to December 1993. Methods and Materials: In this 10-year period, 134 patients of primary vaginal cancers were registered at our hospital. Of these, 75 patients received complete treatment and are analyzed. Results: Disease-free survival (DFS) for the whole group is 50%, and overall survival (OAS) is 60%. Most locoregional recurrences and distant failures are noted in the 2 years following treatment. DFS at 5 years is as follows: Stage I (5 patients), Stage IIA (37 patients), Stage IIB (15 patients), Stage III (14 patients), and Stage IV (4 patients); are 40%, 55%, 60%, 50%, and 25%, respectively. The DFS for patients with complete response (42 patients) to external radiation at 5 years is 68%, with partial response (25 patients) is 35%, and with poor or no response (6 patients) is 18% (p ؍ 0.
Gynecologic Oncology, 1997
Purpose. To evaluate the long-term disease control, survival and complication rates using high-dose-rate intracavitary brachyther-Cancer of the uterus remains the most common gynecoapy (HDRB) and external beam radiotherapy (EBRT) for patients logical malignancy in the 1990s with an estimated 34,000 found to have isolated vaginal recurrences from early-stage endocases in 1996 in the United States [1]. The cornerstone of metrial adenocarcinoma following total abdominal hysterectomy treatment for early-stage endometrial carcinoma (i.e., FIGO and bisalpingo-oophorectomy (TAH BSO).
2013
Expert Panel on Radiation Oncology–Gynecology: Larissa J. Lee, MD; Anuja Jhingran, MD; Elizabeth Kidd, MD; David K. Gaffney, MD, PhD; 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.