PV QA 4 - Poster Viewing Q&A 4
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.
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