Outcomes after radiation therapy with concurrent weekly platinum-based chemotherapy or every-3–4-week 5-fluorouracil-containing regimens for squamous cell carcinoma of the vulva

Abstract

Objective To compare outcomes in patients with squamous cell carcinoma (SCC) of the vulva treated with radiation (RT) and concurrent weekly platinum-based or every-3–4-week regimens containing 5-fluorouracil (5-FU). Methods Records of 44 patients with vulvar SCC treated with concurrent chemotherapy and radiation (chemoRT) from 1988 to 2008 were reviewed. Rates of disease-free survival (DFS), overall survival (OS), locoregional recurrence (LRR), and distant metastases (DM) were estimated using the Kaplan–Meier method. Results The median age was 63 years (range, 44–90), 84.1% of patients had ECOG performance status 0–1, and patients had FIGO Stage II ( n = 6), III ( n = 31), or IVA ( n = 7) disease. Patients were treated preoperatively ( n = 10), postoperatively ( n = 10), or without surgery ( n = 24). The median RT dose to the vulva was 50.2 Gray (range, 22–75). Concurrent chemotherapy regimens included weekly platinum ( n = 16) or every 3–4 week regimens with 5-FU as the backbone ( n = 28). With a median follow-up of 31.5 months, there was no significant difference in 2-year OS (74.5% vs. 70.0%; p = 0.65), DFS (61.9% vs. 56.0%; p = 0.85), LRR (31.3% vs. 32.9%; p = 0.93), or DM (6.3% vs. 10.6%; p = 0.81) between the weekly platinum and every-3–4-week 5-FU regimens. Twenty patients (45.4%) recurred: 16 LRR, 2 DM, and 2 with both. The clinical and pathologic complete response rates were 58.8% (20/34), and 53.8% (14/26), respectively. There was a higher proportion of grade 3 or higher acute non-skin toxicities in patients receiving every-3–4-week 5-FU (46.1% vs. 13.3%; p = 0.07), but more grade 3 or higher skin toxicity in patients receiving weekly platinum (62.5% vs. 32.0%; p = 0.01). Conclusion OS, response rates, and recurrence rates were not significantly different after RT with concurrent weekly platinum-based versus every-3–4-week regimens containing 5-FU for vulvar SCC.