Definitive image guided (IGRT) intensity-modulated arc radiotherapy (arctherapy) for locally advanced squamous cell carcinoma of the vulva.

Abstract

e16540 Background: To determine early clinical outcome of PET-CT image guided intensity modulated arc radiotherapy with concomitant weekly cisplatin as definitive treatment of locally advanced or loco-regional unresectable relapsed vulvar cancer. Methods: Primary or relapsed (after surgery) patients (pts) with locally or loco-regionally advanced vulvar cancer not amenable to surgery were treated with radiation (RT) plus weekly cisplatin. All pts were planed by PET-CT scan. The decision to irradiate vulva and/or unilateral/bilateral nodes was made independently. Vulva was irradiated if macroscopic tumor was present (64Gy) or free-margins were less than 8mm (50Gy). Radiotherapy was applied to the unilateral or bilateral nodal regions according to nodal involvement/sentinal node/central or lateral vulvar tumor statuses. Principal of one-plus nodal region was applied. Target volumes were delineated together with onc-radiologist. Arctherapy was used. Results: 24 consecutive pts (median age 68 years) were treated during 01.09.2008-30.09.2012. In the initial period IMRT was used (9 pts). Vulva was treated in 20 pts; unilateral nodal RT in 7 pts and bilateral nodal RT in 17 pts. Grade ≥2 skin toxicity was registered in 20 pts, diarrhea in 3 pts., bladder related toxicity in 4 pts. Median follow-up is 15.7 months. 18 pts had complete clinical & radiological remission. 6 pts had treatment failure (residual tumor at 3 months follow-up) and another 6 pts relapsed. Conclusions: Image guided arctherapy is well tolerated and is effective in unresectable locally advanced vulvar cancer pts. Further experience and long-term data with this technique is to be attained.