Primary Vaginal Cancer Research Articles

Dose-response relationship between volume base dose and tumor local control in definitive radiotherapy for vaginal cancer

ObjectiveThis study aimed to establish the dose-response relationship between volume base dose and tumor local control for vaginal cancer, including primary vaginal cancer and recurrent gynecologic malignancies in the vagina.Materials and methodsWe identified studies that reported volume base dose and local control by searching the PubMed, the Web of Science, and the Cochrane Library Database through August 12, 2023. The regression analyses were performed using probit model between volume based dose versus clinical outcomes. Subgroup analyses were performed according to stratification: publication year, country, inclusion time of patients, patients with prior radiotherapy, age, primaries or recurrent, tumor size, concurrent chemoradiotherapy proportion, dose rate, image modality for planning, and interstitial proportion.ResultsA total of 879 patients with vaginal cancer were identified from 18 studies. Among them, 293 cases were primary vaginal cancer, 573 cases were recurrent cancer in the vagina, and 13 cases were unknown. The probit model showed a significant relationship between the HR-CTV (or CTV) D90 versus the 2-year and 3-year local control, P values were 0.013 and 0.014, respectively. The D90 corresponding to probabilities of 90% 2-year local control were 79.0 GyEQD2,10 (95% CI: 75.3–96.6 GyEQD2,10).ConclusionsA significant dependence of 2-year or 3-year local control on HR-CTV (or CTV) D90 was found. Our research findings encourage further validation of the dose-response relationship of radical radiotherapy for vaginal cancer through protocol based multicenter clinical trials.

TRImodal DEfinitive invasive vagiNal carcinoma Treatment (TRIDENT protocol): how a standardized approach may change prognostic outcomes

ObjectiveVaginal carcinoma is a rare malignancy accounting for 1–2% of all gynecological cancers. Surgery has a limited role, while definitive radiotherapy–chemotherapy followed by interventional radiotherapy is considered a valid alternative....

Primary vaginal cancer after hysterectomy for benign conditions: a systematic review of the literature.

Primary vaginal cancer is a rare condition. Some studies have revealed an increased risk of vaginal cancer among patients who have undergone hysterectomy for premalignant and malignant cervical disease. However, there is limited literature available on primary vaginal cancer following hysterectomy for benign conditions. This review aimed to investigate available evidence on clinical characteristics, treatments, and outcomes of primary vaginal cancer following hysterectomy for benign diseases. Additionally, we provide a case of a patient who developed primary vaginal cancer 10 years after undergoing hysterectomy for abnormal uterine bleeding. We conducted a comprehensive literature search on PubMed, Scopus, Web of Science using a combination of title and abstract represented by "hysterectomy", and "vaginal cancer"; "vaginal neoplasm"; and "cancer of vagina". No article type restrictions were applied. Eight studies with a total of 56 cases were included in this review. The main symptom observed was vaginal bleeding. Squamous cancer was found to be the most common type, followed by adenocarcinoma. The majority of vaginal cancer cases occurred approximately 10 years after undergoing hysterectomy. The most common location of the tumor was in the vaginal apex. The management approaches varied and details were available in 25 cases. Among these, 7 cases were treated with radiotherapy alone, 1 case received concurrent chemoradiation therapy, and the of rest of the cases underwent surgery as the primary treatment, with or without additional adjuvant therapy. Data of follow-up was available for 15 cases, with 2 cases resulting in death and 2 cases experiencing recurrence. The other cases were alive and well at the time of considered follow up. Primary vaginal cancer after hysterectomy for benign conditions is an extremely rare condition. It is essential to have high-level evidence to guide the screening and treatment strategy for this rare condition. A part of women who have undergone hysterectomy for benign disorders can benefit from vaginal cytology evaluation. It is reasonable to postpone the initial screening after surgery and to extend the interval between subsequent screenings. Further retrospective case-control trials are expected to determine which specific subgroups of patients mentioned above might most potentially benefit from screening. The treatment decision for vaginal cancer after hysterectomy is more favorable to radiotherapy-based management rather than surgery. Vaginal endometrioid adenocarcinoma may arise from the malignant transformation of endometriosis. More studies are expected to investigate the correlation between these two diseases.

Image-Guided High-Dose-Rate Brachytherapy for Definitive Management of Primary Vaginal Cancer: A Single Institutional Experience

To assess the safety and efficacy of image-guided high-dose-rate brachytherapy (IGBT) alone or in combination with external beam radiation therapy (EBRT) for the treatment of vaginal cancers. The study analyzed patients diagnosed with primary vaginal cancers from 2004 to 2021 who received definitive radiotherapy at a single institution. Interstitial implants were performed using a freehand technique and transvaginal or transrectal-ultrasound for imaging guidance. IGBT was planned using inverse planning simulated annealing (IPSA) software. Data collected and analyzed included patient and tumor characteristics, dose and fractionation, and treatment outcomes. Complications were assessed using CTCAEv4 scores, and descriptive and survival analyses were performed using R-studio. Sixty-six patients met inclusion criteria. Patients were staged as I (14), II (23), III (19), and IV (10) based on revised FIGO 2018 staging. 47 (72%) had squamous cell carcinoma histology, and median age was 65 years. The most common regimen was 45 Gy in 25 fractions of EBRT followed by IGBT boost of 18 Gy in 3 fractions with 1 implant (n = 40). For melanoma, an IGBT boost of 19 Gy in 2 fractions with a single implant was used (n = 7). For IGBT monotherapy, the most common regimen was 36 Gy in 6 fractions delivered over 2 implants (n = 3). 41 (66%) of the patients received systemic therapy. Local failures occurred in 8 (12%) patients, while 8 (12%) developed distant metastases. Median overall survival was 64.7 months. Overall survival was 64.3% (95% CI 51.9-79.7%) at 3 years, and 50.9% (95% CI 35.7-72.5%) at 5 years. Grade 3 or 4 toxicities were reported in 4 (6%) patients including vaginal fistula (n = 3) and urethral stricture (n = 1). The results suggest that utilizing IGBT for freehand interstitial implants in combination with EBRT is a safe and effective primary treatment for vaginal cancer, with durable local control and low toxicity. Further research is needed to establish multi-institutional practice patterns and recommendations.

PO34: Vaginal Mucosa Dosimetry for Primary Cervical and Vaginal Cancers Undergoing Perineal Template Interstitial High-Dose-Rate Brachytherapy

PO34: Vaginal Mucosa Dosimetry for Primary Cervical and Vaginal Cancers Undergoing Perineal Template Interstitial High-Dose-Rate Brachytherapy

Solitary Metastasis in the Tibia as a Feature of Primary Squamous Vaginal Carcinoma

Aim: Primary vaginal cancer is rare, comprising about 3% of all gynaecological malignancies. Solitary bone metastases to appendicular skeleton are extremely rare and there are only few published reports. We report the case of isolated metastasis in the tibia as a feature of primary squamous vaginal carcinoma. We present this case because of its rarity and for documentation and discussion purposes. Case report: We present a case of a 44-year old woman diagnosed with squamos vaginal cancer in June 2015. Computed tomography of the thorax, abdomen and pelvis revealed no distant metastases. She was treated with interstitial intracavitary brachytherapy and concomitant chemoradiotherapy. In March 2016 she was admitted to our hospital because of the swelling and the pain in the lower right leg. There was no history of trauma and plain radiographs were normal. Two months later, after further progression of pain, plain radiographs showed intramedullary permeative bone lesion with cortical disruption of tibial dyaphisis and local soft tissue swelling. MRI and core needle biopsy confirmed vaginal cancer metastasis containing tumor cells identical to the primary tumor. The patient was treated with radiotherapy and chemotherapy. Despite the treatment there was further progression of the disease with multiple bone metastases and eventually lung and brain metastases. Conclusion: This case report is another reminder that although extremely rare, solitary metastatic bone lesions of vaginal cancer are possible. Since symptoms mimic various benign conditions, it is important to consider bone metastasis as possible diagnosis in patients with progressive bone pain not responding to analgesic treatment.

The Role of P16, P53, KI-67 and PD-L1 Immunostaining in Primary Vaginal Cancer.

To analyze clinical, pathological and immunohistochemical correlates of survival in vaginal cancer patients. Retrospective analysis of primary vaginal cancer patients, treated at the Department of Gynecology and Gynecological Oncology of the University Hospital Bonn between 2007 and 2021. The study cohort comprised 22 patients. The median age was 63 years (range: 32-87 years). Squamous cell histology was present in 20 patients. Five-year OS in Stage I, II, III and IV was 100%, 56.25%, 0% and 41.67%, respectively (p = 0.147). Five-year DFS was 100%, 50%, 0% and 20.83%, respectively (p = 0.223). The 5-year OS was significantly reduced in the presence of nodal metastasis (p = 0.004), lymphangiosis (p = 0.009), hemangiosis (p = 0.002) and an age above 64 years (p = 0.029). Positive p 16 staining was associated with significantly improved OS (p = 0.010). Tumoral and immune cell PD-L1 staining was positive in 19 and in 16 patients, respectively, without significant impact on OS; 2 patients with metastastic disease are long-term survivors treated with either bevacizumab or pembrolizumab. P16 expression, absence of lymph- or hemangiosis, nodal negative disease and an age below 64 years show improved survival rates in PVC. Tumoral PD-L1 expression as well as PD-L1 expression on immune cells is frequent in PVC, without impacting survival. Within our study cohort, long-term survivors with recurrent PVC are treated with anti-VEGF and immunotherapy.

PO30 Presentation Time: 10:30 AM: Intracavitary Brachytherapy Using a Shielded Cylinder, Clinical Use and Patient Toxicity

<h3>Purpose</h3> The utility of shielded cylinder intracavitary brachytherapy applicators in clinical practice has not been reported. We evaluated patients treated using this applicator to report its use in clinical practice and toxicity following treatment. <h3>Materials and Methods</h3> This single institution retrospective study included all patients who received high-dose rate (HDR) intracavitary brachytherapy using a shielded cylinder applicator (#GM11003380, Varian Systems, Palo Alto, CA) as a component of treatment between July 2013-November 2021. Treatment parameters, dosimetry; tumor and treatment characteristics were abstracted from the medical record. Patient toxicities were collected prospectively through an institutional radiation toxicity database. <h3>Results</h3> A total of 48 patients received 188 HDR intracavitary brachytherapy treatments, with 157 using a shielded cylinder. The majority (90%) also received external beam radiation (EBRT) to a median dose of 4500cGy in 25 fractions (interquartile range, IQR, 4500-5625cGy). Common fractionations (fx) for brachytherapy included 2000cGy/4fx with EBRT for patients with recurrent uterine cancer, 2000-2800cGy/4fx with EBRT or 3000cGy/5fx without EBRT for patients with primary vaginal or vulvar cancer, and 500cGy/1fx with EBRT for rectal cancer patients. The median total EBRT + brachytherapy EQD2 was 6930cGy (IQR 6930-7900cGy). In the treatments delivered with a shielded cylinder, shielding was used to reduce dose to rectum (51%), uninvolved vagina (34%), and bladder/urethra (8%). The most common shielding pattern was 180° (78%) and 90° (20%), with a minority of treatments using 270° shielding (2%). In cases where shielding was used to reduce rectal dose, the D2cc[Gy] rectal dose in delivered plans was 1.18Gy (range 0.53 - 3.92Gy). In patients who had both unshielded and shielded treatment plans, the D2cc[Gy] rectal dose was reduced from 4.07Gy to 1.69Gy, respectively. The median total EQD2 rectal dose in patients who received EBRT in 25 fractions in addition to brachytherapy was 38.9Gy (range 14.8 - 47.8Gy). Acute grade 2-3 toxicities included dermatitis (9), cystitis (4), proctitis (3), fatigue (2), nausea (2), pain (2), and anemia (1). In patients who received brachytherapy alone there were no grade 2+ toxicities reported. Late grade 2-3 toxicities reported 6+ months after radiation therapy included vaginal stricture (4), vaginal dryness (1), fatigue (1), lower GI hemorrhage (1), lymphedema (1), urinary frequency (1), and urinary incontinence (1). One patient had a grade 3 vaginal fistula noted at 6-months. There was one grade 2 sacral insufficiency fracture noted at 4-months. There were no acute or late grade 4-5 toxicities. Median follow-up was 35 months (IQR 11-55 months). Fifteen patients died, 6 from cancer progression and 9 from non-cancer causes. Fifteen patients had cancer progression at a median of 28 months from completion of brachytherapy. Five patients had local-only failures, 9 patients had distant-only failures, and 1 patient had pelvic nodal failure. There was no difference in total EQD2 delivered to tumor between those patients who had local failure versus local control, with a median EQD2 of 69.3Gy and 69.5Gy, respectively. The location of local failure was in the unshielded area in three patients and involved the shielded area in two patients. <h3>Conclusions</h3> Shielded cylinder applicators can be utilized successfully in the treatment of well selected patients with primary and recurrent gynecologic cancers and rectal cancers, enabling dose reduction to non-target structures with low treatment-related toxicity.

Acute and Long-Term Toxicity of Whole Pelvis Proton Radiation Therapy for Definitive or Adjuvant Management of Gynecologic Cancers

<h3>Purpose/Objective(s)</h3> The purpose of this study is to characterize long term toxicity and clinical outcomes of patients treated with whole pelvis (WP) pencil beam scanning proton therapy (PBSPT) for gynecologic malignancies. <h3>Materials/Methods</h3> We retrospectively reviewed the records of 23 patients treated from 2013 to 2019 with WP PBSPT for endometrial, cervical and primary vaginal cancer at our institution. We report acute and late Grade (G) 2 or higher toxicities, graded by physicians and nurses according to the Common Terminology Criteria for Adverse Events, Version 5. The late period was defined as greater than 6 months from end of RT. Disease outcomes, including freedom from (FF) local recurrence, FF regional recurrence, FF distant recurrence, and FF any recurrence were assessed using the Kaplan-Meier method. <h3>Results</h3> Median age was 59 years. 12 (52%) of patients had uterine cancer, 10 (43%) had cervical, 1 (4%) had vaginal. 22 (96%) had intermediate-high risk disease. 20 (87%) were treated post operatively. 3 (13%) received definitive chemoRT. The median PBSPT dose was 50.4 Gy (range, 45-62.5). 10 (43%) received an additional brachytherapy boost. 22 patients (96%) received chemotherapy, 12 of those concurrently with RT. Median follow up was 57.7 months. 5-year actuarial FF local recurrence was 95.5%, FF regional recurrence was 90.9%, FF distant recurrence was 74.7%, and FF any recurrence was 71.2%. There were 2 deaths related to cancer progression. In the acute period, 2 patients (8.6%) had G2 genitourinary (GU) toxicity. 5 had G2 and 1 had G3 gastrointestinal (GI) toxicity, for a total of 6 patients (26%) with G2-3 GI toxicity. 17 (74%) had G2-4 hematologic (H) toxicity. In the late period, 3 patients (13%) had G2 GU toxicity, 1 (4%) had G2 GI toxicity, and 2 (8.6%) had G2-3 H toxicity. <h3>Conclusion</h3> WP PBSPT for gynecologic malignancies delivers favorable locoregional disease control with the majority of recurrences occurring at distant sites. Rates of GU and GI acute and late toxicity are low. Acute hematologic toxicity was most common, likely related to chemotherapy.

Outcomes of 3D MRI Based HDR Brachytherapy with Hybrid Multichannel Vaginal Cylinder Applicator and Freehand Needles for Treatment of Vaginal Disease

<h3>Purpose/Objective(s)</h3> Multichannel vaginal cylinder (MCVC) is unable to cover residual vaginal cancer >7 mm thick or with supra-vaginal extension. Freehand needles inserted directly into areas of disease can extend isodose lines to allow for better coverage of disease if clinically indicated. We report outcomes of use of MCVC with freehand needles at our institution. <h3>Materials/Methods</h3> All patients with malignancies involving vagina treated from 2014-2021 with HDR BT at our institution with MCVC with freehand needles were identified. Clinical characteristics including primary malignancy, initial stage, date of diagnosis and recurrence (if applicable), prior RT, use of EBRT, and BT dose and fractionation were collected. Number of freehand needles used per fraction, 3D imaging used for planning, high-risk clinical target volume (HR-CTV) at each fraction, dose to 2cc (D2cc) of organs at risk, and HR-CTV D90 were recorded. Initial response based on examination and imaging and overall local control outcomes were recorded. Local failure was defined as time to recurrence either within HR-CTV or marginal failure, calculated from date of last BT fraction, with censorship at date of last follow-up. Local control was analyzed via Kaplan-Meier method. <h3>Results</h3> 33 patients were identified with median follow-up 1.9 years (IQR 1.0-2.9 years). 19 patients (57.6%) had primary endometrial cancer with vaginal recurrence/disease. Remaining patients had primary vaginal cancer or involvement secondary to other primaries. 8 patients had recurrent disease after previous course of RT. 24 patients received EBRT with median dose of 45 Gy in 25 fractions, with remaining patients treated with BT alone. BT prescription dose ranged from 20-36 Gy in 3-7 fractions, with a total of 168 BT fractions delivered. Median number of freehand needles utilized was 3, with freehand needles utilized in 157/168 total fractions. MRI-based plan was done for at least 1 fraction in 30 patients (90.9%). Median HR-CTV at time of BT was 19.7cc. Median D2cc to the bladder, rectum, and sigmoid were 56.4 Gy, 55.7 Gy, and 45.4 Gy, respectively. Median D90 to the HR-CTV for pts treated with EBRT plus BT was 76.7 Gy and for BT alone was 48.8 Gy. 29 patients (87.9%) had complete local response to BT on initial examination and/or follow-up imaging. 1 and 2-year local control rates for those who did not have prior RT was 89.5% and 89.5%, respectively. 1 and 2-year local control rates for those who had previous RT was 58.3% and 29.2%, respectively. 1 patient had vaginal laceration requiring surgical repair and 1 patient with disease progression developed small bowel obstruction 1 month after BT, with no additional acute grade 3+ toxicities identified. <h3>Conclusion</h3> Our approach with MCVC plus freehand needles with MRI-based planning was feasible and safe. Initial local response is excellent, with acceptable local control rates and low rate of serious acute toxicities. Multi-institutional experiences are needed to further validate this approach for treatment of vaginal disease.

Outcomes of 3D MRI based HDR brachytherapy with hybrid multichannel vaginal cylinder applicator and freehand needles for treatment of vaginal disease

Freehand needles can be used with multichannel vaginal cylinders (MCVC) to cover vaginal cancer >7 mm thick or with supra-vaginal extension. We report our institutional outcomes using this novel hybrid technique.Patients with vaginal malignancies treated with HDR BT using MCVC plus freehand needles from 2014-2021 at our institution were identified. Clinical characteristics, details of brachytherapy, initial response, and overall local control (LC) outcomes were recorded. LC was analyzed via Kaplan-Meier method.34 patients were identified with median follow-up 1.9 years. 19 patients had primary endometrial cancer with vaginal recurrence/disease, and remaining had primary vaginal cancer or other primaries. 7 patients had recurrence after previous RT course. 25 patients received EBRT with median dose 45 Gy in 25 fractions, and rest received BT alone. Median HR-CTV D90 for patients treated with EBRT plus BT was 77.4 Gy.30 patients had complete local response to BT on initial examination and/or follow-up imaging. 1 and 2-year LC rates in patients without prior RT treated with EBRT + BT were 94.1% and 94.1%, respectively. 1 and 2-year LC rates for those without prior RT were 88.1% and 76.4%, respectively. 1 and 2-year LC rates for those with prior RT were 68.6% and 34.3%, respectively. 1 patient had vaginal laceration requiring surgical repair, and 1 patient developed small bowel obstruction 1 month after BT, with no additional acute grade 3+ toxicities identified.Our approach with MCVC plus freehand needles with MRI-based planning was feasible and safe, with excellent initial local response and low rate of serious toxicities.

Development and validation of models for predicting the overall survival and cancer-specific survival of patients with primary vaginal cancer: A population-based retrospective cohort study.

BackgroundNo models have been developed to predict the survival probability for women with primary vaginal cancer (VC) due to VC’s extreme rareness. We aimed to develop and validate models to predict the overall survival (OS) and cancer-specific survival (CSS) of VC patients.MethodsA population-based multicenter retrospective cohort study was carried out using the 2004–2018 Surveillance, Epidemiology, and End Results Program database in the United States. The final multivariate Cox model was identified using the Brier score and Harrell’s C concordance statistic (C-statistic). The decision curve, calibration plot, and area under the time-dependent receiver operating characteristic curve (AUC) were used to evaluate model prediction performance. Multiple imputation followed by bootstrap was performed. Bootstrap validation covered the entire statistic procedure from model selection to baseline survival and coefficient calculation. Nomograms predicting OS and CSS were generated.ResultsOf the 2,417 eligible patients, 1,692 and 725 were randomly allocated to the training and validation cohorts. The median age (Interquartile range) was 66 (56–78) and 65 (55–76) for the two cohorts, respectively. Our models had larger net benefits in predicting the survival of VC patients than the American Joint Committee on Cancer stage, presenting great discrimination ability and excellent agreement between the expected and observed events. The performance metrics of our models were calculated in three cohorts: the training cohort, complete cases of the validation cohort, and the imputed validation cohort. For the OS model in the three cohorts, the C-statistics were 0.761, 0.752, and 0.743. The slopes of the calibration plots were 1.017, 1.005, and 0.959. The 3- and 5-year AUCs were 0.795 and 0.810, 0.768 and 0.771, and 0.770 and 0.767, respectively. For the CSS model in the three cohorts, the C-statistics were 0.775, 0.758, and 0.755. The slopes were 1.021, 0.939, and 0.977. And the 3- and 5-year AUCs were 0.797 and 0.793, 0.786 and 0.788, and 0.757 and 0.757, respectively.ConclusionWe were the first to develop and validate exemplary survival prediction models for VC patients and generate corresponding nomograms that allow for individualized survival prediction and could assist clinicians in performing risk-adapted follow-up and treatment.

Factors that affect survival in vaginal cancer: a seer analysis

This study aimed to investigate the factors that affect survival in vaginal cancer by means of a large population-based database that had been monitored over a 42 year period (1975–2017). It was investigated which factors were most predictive in survival. This study evaluated the factors that affect survival in primary vaginal cancer as one of the rarest gynaecological cancers. Relationships were explored between survival and age and race of patient, in situ/invasive behaviour of tumour, histological type, stage, grade, surgical treatment, and year of diagnosis. Survival rate was found to be higher at younger ages and earlier stages, in in situ and squamous cell carcinomas, in the presence of previous surgery, and diagnosis from 2000 onward. It was shown that other causes were more predictive of mortality in older patients and that mortality due to other causes decreased in patients diagnosed from 2000 onward. Mortalities due to cancer were found to be lower in the patients who had underwent surgery. At the end of this study, an estimation model was developed for 10-year survival in vaginal cancer and software was created for the model. Impact Statement What is already known on this subject? Primary vaginal cancer is very rare, accounting for 2% of female genital tract malignancies. Due to its low incidence and difficulty of its final diagnosis, vaginal cancer has the least amount of data among all female genital tract malignancies. It is difficult for clinicians to estimate the survival with already limited data on vaginal cancer in the literature. What do the results of this study add? Survival rate was found to be higher at younger ages and earlier stages, in in situ and squamous cell carcinomas, in the presence of previous surgery, and diagnosis from 2000 onward. It was shown that other causes were more effective in mortality with older age and that mortality due to other causes decreased in patients diagnosed from 2000 onward. Mortalities due to cancer were found to be lower in the patients who had underwent surgery. What are the implications of these findings for clinical practice and/or further research? It is anticipated that such studies will contribute to the transformation of societal data collection methods into a prospective nature and lead the way for stronger survival estimation models to be developed in days to come.

Innovations in the Management of Vaginal Cancer.

Primary vaginal cancer is a rare gynecologic malignancy. Given the rarity of the disease, standardized approaches to management are limited, and a great variety of therapeutic conditions are endorsed. This paper reviews advances in surgical approaches, radiation, chemoradiation, and immunotherapy. Advances in surgical management including the increasing use of laparoscopic and endoscopic approaches, as well as the novel techniques in vaginal reconstruction, are reviewed. Concurrent chemoradiation remains a mainstay of treatment for vaginal cancer and has improved local control of disease and overall survival. Additionally, with metastatic disease or situations where toxicity from CCRT is unacceptable, systemic therapies including immunotherapy approaches are reviewed.

Pelvic organ prolapse and vaginal cancer: A systematic literature review.

Primary vaginal cancer is a rare gynecologic malignancy. Few cases describing the concurrence of a vaginal tumor with advanced genital prolapse are reported in the literature and there is no consensus on optimal treatment. To investigate available evidence on presentation, treatment, and outcomes of these concurrent conditions. We performed a systematic search of literature indexed on PubMed, Scopus, ISI Web of Science, and Cochrane using a combination of keywords and text words represented by "pelvic organ prolapse", "genital prolapse", and "vaginal cancer", "vaginal carcinoma". No article type restrictions were applied. Twenty-one studies (case reports and two small case series) were incorporated into the review process, for a total of 27 patients. Management usually involved surgery or primary external beam radiation therapy. External beam radiation therapy was reported to be highly associated with the development of vesicovaginal fistula. A surgical approach was the treatment of choice in most cases. Exclusive interstitial brachytherapy was rarely performed. A multidisciplinary approach considering risks and benefits is of the utmost importance to provide counseling and tailor treatment strategy in these complex cases.

Clinical outcomes of patients treated with template-based high-dose-rate interstitial brachytherapy boost for post-operative recurrent gynecological malignancies: A retrospective analysis.

To report the clinical outcomes in patients treated with Martinez universal perineal interstitial template (MUPIT)-based interstitial brachytherapy boost for primary and recurrent vault and vaginal cancers, and to perform a comparative analysis with our previously published series of similar patients. One hundred and seventeen patients treated between January, 2009 and December, 2015 were evaluated. Descriptive statistics for the patterns of relapse, local recurrence-free survival (LRFS), disease-free survival (DFS), overall survival (OS), and late toxicities were carried out. Kaplan-Meier curves were used for survival analysis. All variables with the potential to affect outcomes were tested using log-rank test for statistical significance. At a median follow-up of 63 months, LRFS, DFS, and OS at 3/5 years were 77.1%/74.7%, 61%/52%, and 72.3%/63.1%, respectively. Overall treatment time (OTT) of 56 days did not affect outcomes. Bulky tumors and OTT > 63 days adversely affected LRFS. Overall treatment time also significantly impacted DFS and OS. Grade 3-4 late bladder toxicities were observed in 1.7% patients, and grade 3-4 late rectal toxicities in 5% patients. Compared to our previous series, the outcome in the current series is better in terms of severe late toxicities (5% improvement in rectal toxicity, and 2.7% improvement in bladder toxicity) and OS by 10%. This could be attributed to the increasing use of concurrent chemotherapy and relative optimization strategies for organs at risk. Patients with primary and recurrent vault and vaginal cancers treated with high-dose-rate interstitial brachytherapy boost using MUPIT resulted in modest clinical outcomes and acceptable late toxicities. OTT was the most important factor affecting the outcomes.

Evaluation of dyskerin expression and the Cajal body protein WRAP53β as potential prognostic markers for patients with primary vaginal carcinoma.

Primary vaginal cancer (PVC) is a rare gynaecological malignancy, which, at present, lacks appropriate biomarkers for prognosis. The proteins dyskerin and WD repeat containing antisense to TP53 (WRAP53β), both of which exert their functions in the telomerase holoenzyme complex, have been shown to be upregulated in different cancer types. These proteins have also been proposed as prognostic markers in some types of cancer. The aim of the present study was to examine the expression patterns of dyskerin and WRAP53β in patients with PVC. Moreover, as part of a search for effective biomarkers to evaluate prognosis in PVC, the expression of these two proteins and their potential association with clinical variables and survival were also evaluated. The expression of dyskerin and WRAP53β was assessed in PVC tumour samples from 68 patients using immunohistochemistry. The majority of tumour samples showed low and moderate expression levels of dyskerin. Upregulation of dyskerin in tumour samples was significantly associated with a shorter survival time and a poorer cancer-specific survival rate. WRAP53β was also expressed in most of the cells but was not significantly associated with clinical variables or survival. This study demonstrates that upregulation of dyskerin is significantly associated with poor prognosis. Thus, dyskerin may serve as a promising prognostic marker and a potential putative therapeutic target in PVC.

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Primary vaginal cancer is rare, constituting only 1%-2% of all female genital tract malignancies and only 10% of all vaginal malignant neoplasms. If vaginal malignancy is found in younger women, it is etiologically linked to the persistence of high-risk HPV infections. We report a case of 39-year-old woman presenting with a large cystic inflamed tumor on the left vaginal wall, which open in the lateral vaginal fornix. The biopsy showed the presence of large leukemic papillary carcinoma of the vagina. Unusually, the vaginal mucosa that covered the tumor was intact. According to the localization this structure, clinical presentation and ultrasound picture, this vaginal tumor mimick cystic tumor of Wolff duct or cyst of Gartner

Cancer of the vagina: 2021 update.

Diagnosis of a primary vaginal cancer is rare, as most vaginal tumors are metastatic from another primary site. Although cancer of the vagina is more common in postmenopausal women, an increase in young women being diagnosed with primary vaginal cancer has been reported, especially in countries with a high HIV prevalence. This is associated with persistence of high‐risk HPV infection. The emphasis should be on primary prevention with prophylactic HPV vaccination. Once there is a suspicion of a primary vaginal cancer, this should be confirmed histologically with biopsy. Staging has been done clinically, as with cervical cancer; however, there is a role for imaging in assisting with staging as this is often a difficult assessment. Treatment should be individualized and depends on stage as well as histologic subtype. It is prudent to refer cases to centers of excellence with experience in dealing with this rare gynecological cancer.

Current update on vaginal malignancies.

Primary vaginal cancers are rare and account for 1-3% of all gynecologic malignancies. There are several histological subtypes that affect a wide range of the population. Imaging plays an important role in the diagnosis, staging, and treatment planning of vaginal cancers. This article reviews the relevant anatomy, clinical findings, imaging characteristics, and recent advances in the management of vaginal malignancies.