Abstract
Simple SummaryPrimary vaginal cancer is a rare disease and, consequently, evidence about the outcome of treatment is scarce. The aim of our retrospective, observational multicenter study was to assess the oncological outcome of the nowadays standing treatment for vaginal cancer, namely radio(chemo)therapy, followed by image-guided adaptive brachytherapy (IGABT). Our study confirms the results of the earlier published small monocentric IGABT studies, showing a high local control with acceptable morbidity. Notably, patients with large (T3/T4) tumors especially seem to benefit from volumetric (3D) image-guided brachytherapy, as compared to two-dimensional-based radiotherapy. In addition, although interpreted with caution, as for cervical cancer, a higher dose seems to lead to better local control. These results should, however, be further investigated in a prospective trial.Purpose: This study assessed outcomes following the nowadays standing treatment for primary vaginal cancer with radio(chemo)therapy and image-guided adaptive brachytherapy (IGABT) in a multicenter patient cohort. Methods: Patients treated with computer tomography (CT)–MRI-assisted-based IGABT were included. Retrospective data collection included patient, tumor and treatment characteristics. Late morbidity was assessed by using the CTCAE 3.0 scale. Results: Five European centers included 148 consecutive patients, with a median age of 63 years. At a median follow-up of 29 months (IQR 25–57), two- and five-year local control were 86% and 83%; disease-free survival (DFS) was 73% and 66%, and overall survival (OS) was 79% and 68%, respectively. Crude incidences of ≥ grade-three urogenital, gastro-intestinal and vaginal morbidity was 8%, 3% and 8%, respectively. Lymph node metastasis was an independent prognostic factor for disease-free survival (DFS). Univariate analysis showed improved local control in patients with T2–T4 tumors if >80 Gy EQD2α/β10 was delivered to the clinical target volume (CTV) at the time of brachytherapy. Conclusions: In this large retrospective multicenter study, IGABT for primary vaginal cancer resulted in a high local control with acceptable morbidity. These results compared favorably with two-dimensional (2D) radiograph-based brachytherapy and illustrate that IGABT plays an important role in the treatment of vaginal cancer.
Highlights
Primary vaginal cancer (PVC) is a rare gynecological cancer with an annual incidence of 0.8–1.0/100,000 women, corresponding to less than 3% of all gynecological malignancies [1]
All patients treated in the five centers were consecutively included in the study if they fulfilled the following criteria: histologically confirmed primary vaginal cancer; magnetic resonance imaging (MRI) at time of diagnosis; treatment with curative treatment intent with combined external beam radiotherapy EBRT (+/− concomitant cisplatin) and computer tomography (CT)–MRI guided (Pulsed-dose rate (PDR) or High-dose rate (HDR)) image-guided adaptive brachytherapy (IGABT), or in selected patients brachytherapy alone
Our large contemporary multicenter study confirms the findings of previous small, monocentric studies regarding the role of image-guided brachytherapy in primary vaginal cancer, demonstrating good local and pelvic control of 86% and 83% at two years, respectively
Summary
Primary vaginal cancer (PVC) is a rare gynecological cancer with an annual incidence of 0.8–1.0/100,000 women, corresponding to less than 3% of all gynecological malignancies [1]. ESTRO recommendations for MRI‐gui advanced cervical cancer [12,13], resulted in an improved therapeutic local control and simultaneous reduced late morbidity [9]. ESTRO recommendations for MRI-guided IGABT in locally advanced cervical cancer [12,13], resulted in an improved therapeutic ratio with increased local control and simultaneous reduced late morbidity [9]. More recently this has found its way into the new ICRU-89 report, in collaboration with GEC–ESTRO, for prescribing, recording, and reporting brachytherapy for cervical cancer [8]. Morbidity in the historical radiograph-based studies was reported with varying level of detail, and especially for vaginal morbidity, it probably was underestimated
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
