Gynecological Cancer

PV QA 4 - Poster Viewing Q&A 4

TU_22_3538 - Improved Survival with Definitive Treatment in Vulvar Cancer with Metastatic Disease to the Pelvic Lymph Nodes

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

Improved Survival with Definitive Treatment in Vulvar Cancer with Metastatic Disease to the Pelvic Lymph Nodes
A. Shinde1, R. Li1, Y. J. Chen1, A. Amini1, M. Wakabayashi2, S. Beriwal3, and S. M. Glaser1; 1Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, 2Department of Gynecologic Oncology, City of Hope National Medical Center, Duarte, CA, 3UPMC Hillman Cancer Center, Pittsburgh, PA

Purpose/Objective(s): Vulvar cancer with pelvic nodal involvement is considered metastatic (M1) disease per AJCC staging. The role of definitive therapy and resulting impact on survival has not been defined.

Materials/Methods: Patients with pelvic lymph node-positive vulvar cancer diagnosed from 2009 to 2015 were evaluated from the National Cancer Database. Patients with known metastases to solid organs, unknown receipt of chemo, brachytherapy alone or documented radiation to non-pelvic sites were excluded. Standard demographic variables (race, insurance, distance to facility, etc.), tumor related factors (clinical N stage, tumor size, extent of primary tumor, grade, etc.), and treatment related variables (receipt of surgery, radiation (RT), and/or chemotherapy (CT)) were evaluated. Logistic regression was used to evaluate utilization and generate propensity scores. Overall survival (OS) was evaluated with log-rank test and multivariate Cox proportional hazards modeling (MVA). Two-month conditional landmark analysis was performed.

Results: We identified 1324 women who met the inclusion criteria. Median follow-up was 19 months, 38 months for living patients. CT, RT, and surgery were used in 54%/74%/63% of cases, respectively. The most common combinations of treatment were tri-modality (26.4% of all patients), CT+RT (22.7%), surgery + RT (17.8%) and surgery alone (15.9%). In patients managed nonsurgically, unadjusted 3-year OS for the observation, RT, CT, and chemotherapy and radiation(C+RT) arms was 20%/23%/10%/39%, respectively, with C+RT having improved survival (p≤0.005 for all groups). MVA showed a benefit to RT (HR=0.68, p=.02) and CT (HR=0.63, p=0.003). Additional factors that predicted for worse OS included government insurance and white race. In patients undergoing surgery, those receiving RT had better survival (3-year OS 55% vs 48%, p=0.025). Unadjusted 3-year OS for observation, RT, CT, and C+RT was 48%/51%/44%/58%, respectively, with no significant benefit with the addition of chemotherapy to radiation (p=0.15). Factors that predicted for utilization of radiation included receipt of chemotherapy (OR=10.71, p<0.001), clinical stage N2 (p=0.019), and larger extent of tumor (OR 2.58-3.13, p≤0.018). Multivariate analysis confirmed a survival benefit of radiation (HR=0.72 p=0.007). Factors that predicted for worse OS included age > 65, higher comorbidity scores, community treatment, tumor size >4cm. Having ≤1 regional lymph nodes positive at time of surgery predicted for better OS compared to patients who did not have lymph nodes examined. The benefit of radiation was maintained after propensity score adjustment (HR=0.74 p=0.031).

Conclusion: In this cohort of women with vulvar cancer with positive pelvic lymph nodes, use of both chemotherapy and radiation are associated with improved survival in patients who do not undergo surgery. Surgery followed by adjuvant radiation with or without chemotherapy is associated with better survival than surgery alone.

Author Disclosure: A. Shinde: None. R. Li: None. Y. Chen: None. A. Amini: None. M. Wakabayashi: None. S. Beriwal: None. S.M. Glaser: None.

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