Analyses of treatment outcomes in advanced vulvar cancer: treated with postoperative radiotherapy or definitive radiotherapy/ chemoradiotherapy

Abstract

Background: To investigate the treatment outcomes of patients with locally advanced vulva cancer in our hospital, and to analyze the outcomes of postoperative radiotherapy (PORT) and definitive radiotherapy (RT)/ concurrent chemoradiotherapy (CCRT). Methods: From March 2001 to July 2019, patients with stage III-IVA vulvar squamous cell carcinoma (SCC) treated with RT were retrospectively evaluated. The inclusion criteria were (I) pathologically proven SCC of the vulva; (II) International Federation of Gynecology and Obstetrics (FIGO) stage III-IVA, and IVB with only pelvic lymph node (LN) metastasis; (III) patients receiving PORT or definitive RT/CCRT. Eighteen patients were finally eligible for inclusion in the study. Patients received either surgery with PORT or definitive RT/CCRT. The endpoints were overall survival (OS), local regional relapse-free survival (LRRFS), and distant metastasis relapse-free survival (DMRFS). Results: The patients' ages ranged from 41 to 87 years and the median age was 67 years. The median follow-up for all patients was 16 months, with a range from six to 194 months. The 2-year OS and DFS were 59.7% and 43.9%, respectively. Most patients suffered from grade 1-2 skin (83.3%) and genitourinary (61.1%) acute reactions. Grade 3 skin reactions were found in 3 patients (16.7%), and grade 3 hematological toxicity was found in another 3 patients (16.7%). Late toxicities in the PORT group included cellulitis in 2 patients. Late toxicities in the RT/CCRT group included cellulitis in one patient, skin necrosis and poor healing in 4 patients, and proctitis in one patient. Conclusions: For stage III-IVA vulvar SCC, both PORT and definitive RT are reasonable options according to the clinical status. Skin and genitourinary toxicities should be monitor carefully during the treatment.