Indiana University Experience in the Management of Vaginal Cancer

Abstract

To review our institutional experience in the treatment of primary vaginal cancer and identify predictors for outcome, in particular, recurrence rate. We retrospectively reviewed the charts of 45 patients identified as having primary squamous cell cancer and adenocarcinoma of the vagina and recorded information regarding both patient and tumor characteristics and treatment modalities. Treatment modalities included surgery and radiation with or without chemotherapy (6 patients), radiation alone (30 patients), and chemoradiation (9 patients). Then, univariate and multivariate analyses were used to identify factors, which predicted for recurrence. Kaplan-Meier survival curves were also generated. The median follow-up time for all surviving patients was 5.8 years (range, 9-146 months). The mean and the median minimum tumor doses were 7300 cGy. The 5-year overall survival rate was 71%, and the 5-year progression-free survival rate was 77%. The 5-year overall survival rates by stage were carcinoma in situ with microinvasion and stage I, 92%; stage II, 82%; and stages III and IVA, 20% (P = 0.0005). The 5-year progression-free survival rates by stage were carcinoma in situ and stage I, 92%; stage II, 88%; and stages III and IVA, 30% (P = 0.00049). Of the factors analyzed, only stage predicted for a statistically significant increased risk for recurrence (P = 2.23E-0.05). Early-stage vaginal cancer can be successfully managed with radiation therapy with excellent rates of local control and survival. Patients with stages III and IV disease have a very poor outcome, and more aggressive therapies need to be investigated. Given the limited number of patients treated with chemotherapy and radiation, no definitive conclusions can be made regarding the impact of combined therapy in the management of this disease.