Outcomes and Evaluation of the Role of Radiation and Surgery in Vaginal Melanoma

Abstract

followed by surgical resection. Neoadjuvant treatment appears to be associated with decreased morbidity and acceptable long-term outcomes. We examined the patterns of care for elderly women with locally advanced vulvar cancer. Materials/Methods: Data from the Surveillance, Epidemiology, and End Results (SEER) database was used to examine women with stage III-IVA vulvar cancer treated from 1988-2009. Primary therapy (surgery or radiation therapy) was noted for each patient. For those who received primary surgery, use of adjuvant radiation therapy was noted. For those who underwent primary radiation treatment, use of secondary surgery was noted. Multivariable logistic regression models were developed to examine treatment and Cox proportional hazards models used to determine survival. Results: We identified a total of 2292 women with stage III/IVA vulvar cancer. Surgery was the initial therapy in 1757 (77%) while 535 (23%) were treated primarily with radiation. Of the stage III patients, 80% underwent primary surgery whereas 20% underwent primary radiation. Of the stage IVA patients, 63% underwent primary surgery whereas 37% underwent primary radiation. In a multivariable model, women >75 compared to those <60 (ORZ1.33; 95% CI 1.03-1.72), black women (ORZ1.59; 95% CI, 1.14-2.23) and patients with stage IVA tumors (ORZ2.23; 95% CI, 1.78-2.81) were more likely to receive primary radiation. In addition, women diagnosed with vulvar cancer between 2002 and 2009 were significantly more likely to receive primary radiation than patients diagnosed before 1994 (ORZ1.64; 95% CI, 1.22-2.21). Among women treated with primary radiation therapy, only 17.8% ultimately underwent surgical resection. Five-year survival was 50.5% (95% CI, 47.753.3%) for stage III patients treated initially with surgery and 35.9% (95% CI, 30.6-41.3%) for patients who initially received radiation therapy. Among women with stage IVA tumors, five-year survival was 34.0% (28.0%-40.2%) for the primary surgery cohort compared to 18.4% (11.9%26.0%) for those who received primary radiation therapy. Conclusions: Despite evidence from clinical trials, there is limited use of neoadjuvant radiation for women with locally advanced vulvar cancer. Among women treated primarily with radiation, the majority do not ultimately undergo surgical resection. Further studies to compare the outcomes of surgery and radiation for advanced stage vulvar cancer are needed. Author Disclosure: C.S. Sharma: None. I. Deutsch: None. C. Chao: None. S.N. Lewin: None. T.J. Herzog: None. S. Xuming: None. Y. Lu: None. J.D. Wright: None.