Gynecological Cancer

PV QA 4 - Poster Viewing Q&A 4

TU_22_3537 - Clinical Outcome and Late Toxicity following Definitive Intensity Modulated Radiation Therapy for Squamous Cell Carcinoma of the Vulva

Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3

Clinical Outcome and Late Toxicity following Definitive Intensity Modulated Radiation Therapy for Squamous Cell Carcinoma of the Vulva
A. Rishi1, M. Rollins2, D. C. Fernandez1, K. A. Ahmed1, M. S. Hoffman1, M. M. Shahzad1, S. M. Apte1, J. Y. Chern1, H. S. Chon1, R. M. Wenham1, and M. E. Montejo1; 1H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 2University of South Florida Morsani College of Medicine, Tampa, Florida, Tampa, FL

Purpose/Objective(s): To assess clinical outcomes, toxicity and patterns of failure following definitive intensity modulated radiotherapy (IMRT) for vulvar carcinoma.

Materials/Methods: Between April 2010 and September 2017, 28 histologically confirmed, adequately staged, non-metastatic patients with vulvar squamous cell carcinoma were definitively treated with IMRT/IGRT. Patients were followed until January 2018. The treatment compliance, late toxicities, and patterns of failure were investigated. Loco-regional control (LRC), disease-free-survival (DFS), metastasis-free survival (MFS) and overall survival (OS) were estimated using the Kaplan-Meier method.

Results: The median age of the cohort was 64 (38-92) years. All patients were adequately staged at baseline with PET-CT – 26 (93%) patients or CT – 2 (7%) patients. Surgical staging for suspicious groin nodes was performed in 9 (32%) patients. Groin and/or pelvic nodes were seen in 17 (60.7%) patients (groin-16, pelvic-5). Surgical staging of groin nodes were performed in 9 (32%) patients. Reasons for inoperability were: medical comorbidities (6/28 patients) or extensive disease (22/28 patients). Median RT dose to gross disease was 64.8 Gy (54-76 Gy). Concurrent cisplatin was administered in 20 (71.4%) patients. The compliance to treatment was good with 27 (96.4%) patients completing treatment with treatment interruptions in 6 (21%) patients (median - 6 days). Complete clinical or radiological response was observed in 24 (85%) patients. The patterns of failure were: local – 6, regional – 2 and distant – 4 patients. Salvage surgery was performed in 5 patients for residual/recurrent disease. Median follow-up was 20 (3-74) months, and actuarial 2-year LRC, DFS, MFS and OS were 72.8% [52.4 months (mean); 95% CI 40.3-64.5 months], 60.5% (44.5 months; 95% CI: 31.4-57.6 months), 81.2% (58 months; 95% CI: 47.3-68.7 months), 63.8% (55.7 months; 95% CI: 41.9-69.4 months), respectively. Late toxicities noted at 1-year post-treatment included vaginal stenosis 9 (32%) patients (median time interval – 12 months; 2-year actuarial hazard - 43.6%), grade 3 lymphedema – 2 (7.1%) patients. No grade 4 toxicity was seen.

Conclusion: Definitive radiotherapy is an effective treatment option for vulvar cancer and is well tolerated with good compliance and manageable late toxicity.

Author Disclosure: A. Rishi: None. M. Rollins: None. D.C. Fernandez: None. M.S. Hoffman: None. S.M. Apte: None. R.M. Wenham: None.

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