Oral Presentation ASGO Annual Scientific Meeting 2024

Node-positive Carcinoma of Vulva Treated with Curative-Intent Radiotherapy:  Reported Outcomes from a Large Single Australian Institution (11081)

Julianne O'Shea 1 , Emma Link 2 , Pearly Khaw 1 2 , Andrew Lim 1 , Ming-Yin Lin 1 2
  1. Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
  2. Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Vic, Australia

Background:

Carcinoma of the vulva is an uncommon cancer, accounting for less than 5% of all gynaecological malignancies.1-2 Surgery is the mainstay of curative treatment for early-stage disease whilst definitive chemoradiotherapy (CRT) can be considered for locally advanced disease to avoid the morbidity of extensive surgery3-5. Node-positive disease is often associated with a poor prognosis and poses a management challenge.

 

Aims:

To investigate outcomes of patients with node-positive vulvar carcinoma treated with radiotherapy (RT) +/- chemotherapy with curative intent over a 20-year period, in terms of patterns of failure, failure-free survival (FFS) and overall survival (OS).

 

Methods:

Patients were eligible if they had a histological diagnosis of node-positive vulvar carcinoma and referred to Peter MacCallum Cancer Centre for curative intent radiotherapy +/- chemotherapy either as primary treatment or in the adjuvant setting following definitive surgery between 2000 – 2019. Eligible patients were retrieved from the gynae-oncology unit’s research prospective database where clinical, histopathological information, treatment and follow-up data was collected for statistical analysis.

 

Results:

Eighty-eight women met the inclusion criteria. Median age was 65 years (range 33-90). Sixty-two patients received surgery & adjuvant RT [57/62 had concomitant chemotherapy (92%)], 24 patients received definitive CRT and 2 received definitive RT alone. Median dose to gross inguinal nodes (n=43) was 57Gy (range 34-60) and median dose to gross primary disease was 62Gy (n=25) (range 34-64). Median follow-up was 10.8 years (range 1.2-21.4). At 5 years, OS was 54% for the entire cohort; 57% in the patients receiving adjuvant RT and 46% in the definitive group. Forty-four/88 patients (50%) from the entire group (n=88) relapsed, of which 13/44 (30%) failed at the primary site alone. Disease control at the primary site and nodes was achieved in 50/88 patients (57%).

 

Conclusion:

Loco-regional control in patients with node positive vulva carcinoma treated with chemoradiotherapy, with or without surgery is reasonable, with a trend of improved outcomes with a combination of surgery and radiotherapy.

  1. 1.Moore DH. Chemotherapy and radiation therapy in the treatment of squamous cell carcinoma of the vulva: Are two therapies better than one? Gynecologic oncology 2009;113:379-83.
  2. 2. Shylasree TS, Bryant A, Howells RE. Chemoradiation for advanced primary vulval cancer. The Cochrane database of systematic reviews 2011:CD003752.
  3. 3. Han SC, Kim DH, Higgins SA, Carcangiu ML, Kacinski BM. Chemoradiation as primary or adjuvant treatment for locally advanced carcinoma of the vulva. International journal of radiation oncology, biology, physics 2000;47:1235-44.
  4. 4. Landrum LM, Skaggs V, Gould N, Walker JL, McMeekin DS. Comparison of outcome measures in patients with advanced squamous cell carcinoma of the vulva treated with surgery or primary chemoradiation. Gynecologic oncology 2008;108:584-90.
  5. 5. Tans L, Ansink AC, van Rooij PH, Kleijnen C, Mens JW. The role of chemo-radiotherapy in the management of locally advanced carcinoma of the vulva: single institutional experience and review of literature. American journal of clinical oncology 2011;34:22-6.
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