Does time to completion of radiation treatment in locally advanced vulvar cancer impact survival?

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 5593-5593
Author(s):  
Nancy T. Nguyen ◽  
Xiao Zhao ◽  
Matthew Ponzini ◽  
Machelle Wilson ◽  
Gary S. Leiserowitz ◽  
...  
Keyword(s):  
Overall Survival ◽  
Squamous Cell ◽  
Vulvar Cancer ◽  
Radiation Treatment ◽  
Locally Advanced ◽  
Group Versus ◽  
Figo Stage ◽  
Concurrent Chemotherapy ◽  
Stage Ii ◽  
Event Analysis

5593 Background: Although well established in cervical cancer, it is unclear whether time from initiation to completion of radiation therapy for vulvar cancer affects survival outcomes. We seek to assess if completion of radiation, either alone (RT) or as concurrent chemoradiation (CRT), within a planned timeframe in locally advanced squamous cell vulvar cancer impacts overall survival (OS). Methods: Women 18 years or older with FIGO stage II to IVA vulvar cancer who received external beam RT or CRT as part of their initial treatment course were identified from the National Cancer Database from 2004-2017. Patients with non-squamous cell carcinoma histology or who received systemic cytotoxic therapies as primary treatment were excluded. Patients who received less than 20 fractions of radiation were also excluded. Time to radiation completion was the number of days from the initiation to completion of radiation. The delay of radiation completion was calculated as the difference between the actual time to radiation completion and predicted duration of radiation. Types of treatment (RT and CRT) were both stratified into groups based on the delay of radiation completion, less than 7 days or greater than 7 days. Chi-square, Fisher Exact ANOVA and Kruskal-Wallis tests were used for analysis. Kaplan-Meier curves with log-rank tests were fit for univariate time-to-event analysis. Multivariable Cox proportional hazard models were fit to assess effects after controlling for confounding. Results: There were 2378 patients identified for analysis (n = 856 RT and n = 1522 CRT). Median age was 67 (IQR 56-78) and the CRT group was younger (p < 0.0001) than the RT group. The majority were white (88.35%) with advanced FIGO stage III or IVA (72.29 %) disease. Median dose of total radiation was 5720 cGy (IQR 5040-6300) with higher doses observed in the greater than 7 days delay group versus less than 7 days, (p < 0.0001). Median follow up was 27.2 (IQR 11.8-57.9) months. For both cohorts, completion of treatment with delay less than 7 days resulted in significant improvement in median survival when compared to treatment completion delay of more than 7 days: RT (Median OS 34.9 versus 21.6 months, p < 0.01) and CRT (58 versus 41.3 months, p < 0.01). On multivariate subset analysis, both completion of CRT and RT were associated with improved OS when treatment was completed with less than 7 days delay vs greater than 7 days delay, CRT (HR 0.869 [95%CI 0.758-0.997]), RT (HR 0.820 [95%CI 0.698-0.964]). Advanced FIGO stage IVA was associated with the greatest increase in hazard of death, (HR 1.758 [95%CI 1.516-2.039]), compared to FIGO stage II. Conclusions: Completion of radiation with less than 7 days delay is associated with improved overall survival, which is independent of concurrent chemotherapy. These findings suggest that strategies to minimize delays in radiation treatment are crucial in treating locally advanced vulvar cancer.

scholarly journals Prognostic factors in patients with vulvar cancer: the VULCAN study

2020 ◽  
Vol 30 (9) ◽  
pp. 1285-1291 ◽  
Author(s):  
Ignacio Zapardiel ◽  
Sara Iacoponi ◽  
Pluvio J Coronado ◽  
Kamil Zalewski ◽  
Frank Chen ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Squamous Cell ◽  
Vulvar Cancer ◽  
Tumor Resection ◽  
Figo Stage ◽  
Primary Treatment ◽  
Resection Margins ◽  
Stromal Invasion ◽  
Case Volume

ObjectiveThis study aimed to analyze the prognostic factors for overall and progression-free survival in patients with vulvar cancer.MethodsThis international, multicenter, retrospective study included 2453 patients diagnosed with vulvar cancer at 100 different institutions. Inclusion criteria were institutional review board approval from each collaborating center, pathologic diagnosis of invasive carcinoma of the vulva, and primary treatment performed at the participating center. Patients with intraepithelial neoplasia or primary treatment at non-participating centers were excluded. Global survival analysis and squamous cell histology subanalysis was performed.ResultsAfter excluding patients due to incomplete data entry, 1727 patients treated for vulvar cancer between January 2001 and December 2005 were registered for analysis (1535 squamous, 42 melanomas, 38 Paget’s disease and 112 other histologic types). Melanomas had the worse prognosis (p=0.02). In squamous vulvar tumors, independent factors for increase in local recurrence of vulvar cancer were: no prior radiotherapy (p<0.001) or chemotherapy (p=0.006), and for distant recurrence were the number of positive inguinal nodes (p=0.025), and not having undergone lymphadenectomy (p=0.03) or radiotherapy (p<0.001), with a HR of 1.1 (95% CI 1.2 to 1.21), 2.9 (95% CI 1.4 to 6.1), and 3.1 (95% CI 1.7 to 5.7), respectively. Number of positive nodes (p=0.008), FIGO stage (p<0.001), adjuvant chemotherapy (p=0.001), tumor resection margins (p=0.045), and stromal invasion >5 mm (p=0.001) were correlated with poor overall survival, and large case volume (≥9 vs <9 cases per year) correlated with more favorable overall survival (p=0.05).ConclusionsAdvanced patient age, number of positive inguinal lymph nodes, and lack of adjuvant treatment are significantly associated with a higher risk of relapse in patients with squamous cell vulvar cancer. Case volume per treating institution, FIGO stage, and stromal invasion appear to impact overall survival significantly. Future prospective trials are warranted to establish these prognostic factors for vulvar cancer.

Neoadjuvant chemotherapy followed by radical surgery in locally advanced vulvar carcinoma: a single-institution experience

2021 ◽  
pp. 030089162110276
Author(s):  
Adorni Marco ◽  
Bazzurini Luca ◽  
Lissoni Andrea Alberto ◽  
Vecchione Francesca ◽  
Negri Serena ◽  
...  
Keyword(s):  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
Partial Response ◽  
Vulvar Cancer ◽  
Elderly Women ◽  
Radical Surgery ◽  
Locally Advanced ◽  
Complete Response ◽  
Tumor Burden ◽  
Clinical Response Rate

Background: Squamous cell carcinoma of the vulva is a rare malignancy that affects elderly women. About one-third of vulvar cancers are diagnosed in an advanced stage, requiring extensive surgery. Neoadjuvant chemotherapy (NACT) has been introduced to reduce local tumor burden. In this retrospective study, we analyze the efficacy and toxicity of NACT followed by radical surgery. Methods: Patients with locally advanced vulvar cancer (LAVC) treated at our institution with neoadjuvant platinum and paclitaxel-based chemotherapy ± ifosfamide followed by surgery at our institution were retrospectively identified. Results: Fourteen patients (93%) completed NACT with tolerable toxicities (G3–G4 toxicity: 30%). Thirteen patients (87%) underwent surgery. The overall clinical response rate on vulvar disease was 66% (20% complete response, 46% partial response), confirmed by histopathologic analysis, while on inguinal lymph nodes it was 69% (23% complete response, 46% partial response). At the pathologic examination, all patients had negative surgical margins. Three out of 9 patients (33%) with lesions infiltrating the urethral meatus and 4 patients out of 7 (57%) with anal involvement did not require urethral amputation or colostomy, respectively, after NACT. No severe postoperative complications were described. Overall survival at 5 years was 60%, and median overall survival was 76 months. Conclusion: NACT followed by surgery in locally advanced vulvar cancer is well tolerated and allows surgical modulation.

Proton beam radiotherapy of locally advanced or recurrent conjunctival squamous cell carcinoma: experience of the CATANA Centre

2020 ◽  
pp. 1-8
Author(s):  
Roberto Milazzotto ◽  
Rocco Luca Emanuele Liardo ◽  
Giuseppe Privitera ◽  
Luigi Raffaele ◽  
Vincenzo Salamone ◽  
...  
Keyword(s):  
Overall Survival ◽  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Proton Beam ◽  
Squamous Cell ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Proton Beam Radiotherapy ◽  
Conjunctival Squamous Cell Carcinoma ◽  
The Impact

Abstract Aim: Conjunctival squamous cell carcinoma (SCC) is a rare tumour of the ocular region and microscopic radical surgical is difficult. There are no single guidelines for therapeutic management and the role of radiation therapy is not clearly defined although conventionally photon or electron beams are used. Proton beam radiotherapy (PBRT) is a new option for a conservative approach and allows good sparing of the organs at risk. Materials and methods: After surgical resection, we collected 15 cases treated at our institution with PBRT. The dose delivered was between 48 and 60 Gy relative biological effectiveness (RBE), with fractions of 12–15 Gy RBE. Results: After an average period of 48 months, the patients achieved excellent disease control (overall survival and disease-free survival: 86·6%), with minimal acute and late toxicity. Findings: In this work, we present our experience on the use of PBRT technique in SCC treatment. A larger sample of patients is needed to draw conclusions about the impact of this treatment on disease recurrence and overall survival.

scholarly journals A Cross Sectional Study on Loco-Regional Recurrences and Overall Survival Rate among Patients with Stage II (T2N0M0) Glottis Carcinoma Treated with Chemoradiation and Surgery

2021 ◽  
Vol 8 (04) ◽  
pp. 219-223
Author(s):  
Niharika Darasani
Keyword(s):  
Overall Survival ◽  
Survival Rate ◽  
Squamous Cell ◽  
Stage Ii ◽  
Overall Survival Rate ◽  
Disease Specific Survival ◽  
Free Survival ◽  
Tertiary Teaching ◽  
Voice Preservation ◽  
Disease Specific

BACKGROUND Single modality treatment for stage I and stage II squamous cell carcinomas of glottis region gave excellent results. Since a long time these are treated either with definitive radiation therapy or surgical excision with endoscopes. There was not much difference with regard to voice preservation, local recurrence and disease-free survival period. Our aim was to study the clinical presentation and management protocol of glottis carcinoma in a tertiary hospital and observe the final outcome of stage II (T2N0M0) glottis carcinoma and specific factor for survival in patients treated with surgery, radiotherapy and concurrent chemoradiation. METHODS 43 patients of glottis carcinoma stage II (T2N0M0) attending a tertiary teaching hospital between May 2015 and April 2017 were included in the study. Demography and smoking status of subjects were recorded. Staging of the disease was according to American Joint Committee on Cancer (AJCC) Staging System 7th edition. Paraglottic space infiltration was taken as a criteria to upgrade the staging. The overall survival rate, recurrence free survival, disease specific survival rate and laryngeal function preservation rate were calculated. RESULTS Out of 43 patients, males were 90.69 % and 09.30 % were females. Male to female ratio was 10.57 : 1. Mean age was 58.62 ± 2.35 years. 67.44 % were current smokers, 27.90 % were former smokers and 02.32 % were non-smokers. The overall survival scores and disease specific survival was 100 % with 11.62 % locoregional recurrences. The voice preservation was 86.04 %. Radiotherapy was used in 72.09 %, chemoradiation in 18.60 % patients and 11.62 % patients underwent surgery. 11.62 % patients presented with locoregional recurrence during 24 months of follow up. 02.32 % patients had to undergo tracheostomy. CONCLUSIONS The overall survival scores and disease specific survival were 100 % with 11.62 % loco-regional recurrence. Voice preservation was 86.04 %. Proactive prevention rather than escalation of treatment protocol gives better prognosis. KEYWORDS Glottis, Larynx, Supra Glottis, Sub Glottis, Squamous Cell Carcinoma, Chemo Radiation and Trans Oral Laryngeal Surgeries

scholarly journals Personalized reconstructive and plastic approach in the surgical treatment of vulvar cancer

2021 ◽  
Vol 20 (2) ◽  
pp. 12-16
Author(s):  
A. A. Mukhin ◽  
A. V. Taratonov
Keyword(s):  
Surgical Treatment ◽  
Squamous Cell ◽  
Vulvar Cancer ◽  
Locally Advanced ◽  
Defect Closure ◽  
Anatomical Structures ◽  
Clinical Center ◽  
Vulvar Reconstruction ◽  
Medial Surfaces ◽  
Treatment Volume

Introduction. The choice of a rational method of treatment in vulvar cancer is one of the most actual and difficult problems of modern clinical oncology. In the majority of cases vulvar cancer occurs in elderly and senile patients, as well as in some patients with locally advanced form. The aim of the investigation was to assess the possibility of reconstruction after surgical treatment of vulvar cancer.Materials and Methods. A study was conducted involving 151 patients with squamous cell vulvar cancer in whom the gynecological oncology department of Chelyabinsk regional clinical center of oncology and nuclear medicine performed surgical treatment by various methods in the following volume: dilated vulvectomy with the resection of adjacent anatomical structures with reconstructive and plastic component.Results. The original ways of plasty of the postoperative wound after vulvectomy were evaluated, the minimum risk of  complications was revealed. The presented technologies permit to use additional variants of the wound defect reconstruction and have a number of advantages in comparison with two dermalfascial flaps from the medial surfaces of the femur used earlier. Discussion. Studies have shown that vulvar reconstruction using skin flaps can avoid complications and improve patients' quality of life. Reconstruction with flaps is not currently an accepted standard of treatment for vulvar cancer. Conclusion. The methods of the wound defect closure are possible after radical vulvectomy in patients with squamous cell vulvar cancer and resection of adjacent anatomical structures without reduction of surgical treatment volume. These methods of wound defect closure contribute to the reduction of postoperative complications and significantly reduce postoperative stay in a medical institution.

Primary Versus Preoperative Radiation for Locally Advanced Vulvar Cancer

2017 ◽  
Vol 27 (4) ◽  
pp. 794-804 ◽  
Author(s):  
Divya Natesan ◽  
Julian C. Hong ◽  
Jonathan Foote ◽  
Julie A. Sosa ◽  
Laura Havrilesky ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Confidence Interval ◽  
Vulvar Cancer ◽  
Locally Advanced ◽  
Concurrent Chemotherapy ◽  
Primary Radiation ◽  
Rank Test ◽  
Preoperative Radiation ◽  
Preoperative Radiation Therapy ◽  
American Joint Committee

ObjectivesThe objective of this study was to evaluate patterns of care and the survival impact of primary radiation and preoperative radiation therapy with surgery in women with locally advanced vulvar cancer using a large national cohort.Methods and MaterialsWomen with vulvar cancer, diagnosed from 2004 to 2012, who received primary or preoperative radiation therapy were identified in the National Cancer Database. Patient characteristics, such as age, race, American Joint Committee on Cancer stage, and comorbidity score, were compared between those that received primary radiation only and those that received preoperative radiation with surgery using the χ2, Fisher exact, and Mann-Whitney tests as appropriate. Overall survival (OS) by treatment approaches was estimated via the Kaplan-Meier method and compared using the log-rank test. Factors associated with OS were determined using univariate and multivariate Cox proportional hazards regression models.ResultsA total of 2046 women were identified; 1407 of these women (69%) received primary radiation therapy (RT; n = 421) or chemoradiation therapy (CRT; n = 986) (RT/CRT), and 639 women (31%) received preoperative RT (n = 92) or CRT (n = 547) followed by surgery (RT/CRT + S). The American Joint Committee on Cancer staging distributions were as follows: T1 (n = 152), T2 (n = 1436), T3 (n = 405), N0 (n = 899), N1 (n = 480), N2 (n = 445), and N3 (n = 40). Median follow-up was 21.9 months. Primary RT/CRT was associated with compromised OS, compared with preoperative RT/CRT + S (41.7% vs 57.1% at 3 years, respectively; P < 0.001). On multivariate analysis, OS associated with primary RT/CRT with doses more than 55 Gy was not significantly different from RT/CRT + S (hazards ratio, 1.139; 95% confidence interval, 0.969–1.338; P = 0.116). Use of concurrent chemotherapy improved OS of primary RT with doses more than 55 Gy compared with CRT + S (hazards ratio, 1.107; 95% confidence interval, 0.919–1.334; P = 0.234).ConclusionsIn a large nationwide analysis, primary nonsurgical management of vulvar cancer with RT was associated with compromised survival compared with preoperative RT with surgery. However, with doses more than 55 Gy and concurrent chemotherapy, nonoperative approaches had comparable survival compared with preoperative CRT + S.

Sign in / Sign up

Export Citation Format

Share Document