Concurrent Chemoradiation for Vaginal Cancer

David T Miyamoto,Akila N Viswanathan,Sharon A Glynn

doi:10.1371/journal.pone.0065048

Abstract

BackgroundIt is not known whether the addition of chemotherapy to radiation therapy improves outcomes in primary vaginal cancer. Here, we review clinical outcomes in patients with primary vaginal cancer treated with radiation therapy (RT) or concurrent chemoradiation therapy (CRT).MethodsSeventy-one patients with primary vaginal cancer treated with definitive RT with or without concurrent chemotherapy at a single institution were identified and their records reviewed. A total of 51 patients were treated with RT alone; 20 patients were treated with CRT. Recurrences were analyzed. Overall survival (OS) and disease-free survival (DFS) rates were estimated using the Kaplan-Meier method. Cox regression analysis was performed.ResultsThe median age at diagnosis was 61 years (range, 18–92 years) and the median follow-up time among survivors was 3.0 years. Kaplan-Meier estimates for OS and DFS differed significantly between the RT and CRT groups (3-yr OS = 56% vs. 79%, log-rank p = 0.037; 3-yr DFS = 43% vs. 73%, log-rank p = 0.011). Twenty-three patients (45%) in the RT group had a relapse at any site compared to 3 (15%) in the CRT group (p = 0.027). With regard to the sites of first relapse, 10 patients (14%) had local only, 4 (6%) had local and regional, 9 (13%) had regional only, 1 (1%) had regional and distant, and 2 (3%) had distant only relapse. On univariate analysis, the use of concurrent chemotherapy, FIGO stage, tumor size, and date of diagnosis were significant predictors of DFS. On multivariate analysis, the use of concurrent chemotherapy remained a significant predictor of DFS (hazard ratio 0.31 (95% CI, 0.10–0.97; p = 0.04)).ConclusionsVaginal cancer results in poor outcomes. Adequate radiation dose is essential to ensure curative management. Concurrent chemotherapy should be considered for vaginal cancer patients.

Highlights

Vaginal cancer is a rare disease, comprising only 1%–2% of all gynecologic malignancies
We identified 71 patients with primary vaginal cancer treated with definitive radiation therapy (RT) with or without concurrent chemotherapy at Brigham & Women’s Hospital/Dana-Farber Cancer Institute between 1972 and 2009
A total of 51 patients were treated with RT without chemotherapy and 20 were treated with chemoradiation therapy (CRT)

Summary

Introduction

Vaginal cancer is a rare disease, comprising only 1%–2% of all gynecologic malignancies. Known prognostic factors for recurrence of vaginal cancer include stage, lymph node involvement [1,2], size of the initial lesion [3] and advanced age [4]. Over the past two decades, the integration of computed tomography (CT) and magnetic resonance imaging (MRI) for staging has allowed more accurate assessment of nodal involvement and appropriate treatment to suspicious lymph node regions. 3-dimensional (3D) imaging used for radiation planning has facilitated the identification and delineation of the target volume with greater accuracy [9]. It is not known whether the addition of chemotherapy to radiation therapy improves outcomes in primary vaginal cancer. We review clinical outcomes in patients with primary vaginal cancer treated with radiation therapy (RT) or concurrent chemoradiation therapy (CRT)

Methods

Results

Conclusion