Dose-escalated intensity modulated radiation therapy in patients with locally-advanced vulvar cancer - does it increase response rate?

Richman, Adam H.; Vargo, John A.; Ling, Diane C.; Sukumvanich, Paniti; Berger, Jessica; Boisen, M.M.; Edwards, Robert P.; Taylor, S.E.; Courtney‐Brooks, Madeleine; Olawaiye, Alexander; Orr, Brian; Beriwal, Sushil

doi:10.1016/j.ygyno.2020.09.019

Cited by 17 publications

(26 citation statements)

References 16 publications

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“…A history of lichen sclerosis was found in one third of all patients in our study. This number is in agreement with previous studies reporting lichen sclerosis in 31e39% of all patients with vulvar cancer [3,4,16].…”

Section: Discussionsupporting

confidence: 93%

“…In one study, lichen sclerosis was associated with an increased risk for recurrence among 49 patients treated with radio(chemo)therapy in the univariate analysis. The finding was not confirmed in a multivariate analysis [16]. In another study including 201 patients with vulva cancer primarily treated with surgery, lichen sclerosis was identified as the primary risk factor for local failure, with a three-fold increase in local failure after surgery among patients with pre-existing lichen sclerosis [3].…”

Section: Discussionmentioning

confidence: 95%

“…tumour stage and size, lymph node metastases and increasing age have been found to impact negatively on the local control rate and survival outcomes [17,22]. Moreover, lichen sclerosis and HPV-negative tumours have been associated with poor outcomes [3,4,16].…”

Section: Discussionmentioning

confidence: 99%

“…In the first study, 49 patients were treated with preoperative or definitive radio(chemo)therapy with 59.4e66.0 Gy. In the preoperative patients, complete clinical and pathological response rates of 76% and 70%, respectively, were obtained [16]. In the second study, 26 patients were treated with definitive radio(chemo)therapy and they obtained a complete clinical response rate of 80% [18].…”

Section: Discussionmentioning

confidence: 99%

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Lichen Sclerosis is Associated With a High Rate of Local Failure After Radio(chemo)therapy for Vulvar Cancer

et al. 2022

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Aims: Radio(chemo)therapy plays an important role in the treatment of vulvar cancer, either as postoperative treatment or as definitive treatment in patients who present with inoperable disease. Only limited data are available regarding outcome after modern state of the art radio(chemo)therapy and more information regarding prognostic factors are warranted. The aim of this study was to evaluate disease outcomes after radio(chemo)therapy in patients with vulvar cancer with special emphasis on the impact of lichen sclerosis on local control. Materials and methods: All consecutive patients (n ¼ 109) from the western half of Denmark who were treated with definitive (n ¼ 52) or postoperative (n ¼ 57) radio(chemo)therapy between January 2013 and January 2020 were included. Local control, cause-specific survival and overall survival, as well as morbidity, were analysed using KaplaneMeier statistics. Prognostic factors for local control were analysed in univariate and multivariate analysis. Results: At a median follow-up of 35 (4e95) months, 46 (42.0%) patients were diagnosed with recurrence. Eighty per cent of the recurrences were located to the vulva region, leading to a 5-year local control of 58.9% (confidence interval 47.9e69.9). Cause-specific survival was 62.9% (confidence interval 53.1e72.7), whereas overall survival was 58.0% (confidence interval 47.6e68.5). Grade 3e4 morbidity was diagnosed in 10 (9%) patients. Lichen sclerosis (hazard ratio 3.89; confidence interval 1.93e7.79) was an independent risk factors for local recurrence. Patients without lichen sclerosis had a 5-year local control rate of 83.6% (confidence interval 67.2e99.0) and 62.6% (confidence interval 43.2e82.0) after postoperative and definitive radio(chemo)therapy, respectively. In patients with lichen sclerosis, the local control rate was 44.0% (confidence interval 19.3e69.0) and 17.6% (confidence interval 0e30.0) after postoperative and definitive radio(chemo)therapy, respectively. Conclusion: Radio(chemo)therapy plays an important role in the treatment of vulvar cancer. However, despite dose escalation, a substantial proportion of patients experienced local relapse. Pre-existing lichen sclerosis seems to have a significant impact on the risk of recurrence. This should influence surveillance programmes for these patients.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Lichen Sclerosis is Associated With a High Rate of Local Failure After Radio(chemo)therapy for Vulvar Cancer

et al. 2022

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“…However, we accept that there was no control arm who received chemo(radiotherapy) without upfront NACT. Our results (3-year OS 52.5%) reconcile with a review of the National Cancer Database reporting 5-year OS of 27.4% (radiotherapy alone) and 49% (CRT) in locally advanced vulval cancer [28,30], although enhanced outcomes may be achieved with dose escalated intensity modulated radiotherapy [31].…”

Section: Results In the Context Of Published Literaturesupporting

confidence: 86%

Retrospective cohort study of neoadjuvant chemotherapy followed by tailored surgery in locally advanced sphincter-threatening vulval cancer: an alternative to exenteration?

2021

EJGO

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To determine the feasibility and overall survival (OS) outcome of utilizing neoadjuvant chemotherapy (NACT) followed by wide local excision (WLE) in women with sphincter-threatening locally advanced squamous cell carcinoma (SCC) of the vulva. Methods: The electronic chemotherapy prescribing system was used to identify patients from the West of Scotland Cancer Network (WoSCAN) who received NACT over a 5 year period, January 2012 to December 2016 inclusive. Baseline characteristics and treatment details were collected. Association of treatment type and other variables with OS were analysed using Cox proportional hazards model. Results: 57 patients with newly diagnosed SCC of the vulva were identified; recurrences were excluded. 25 patients proceeded to WLE following NACT. No permanent stomas were required. 4% of patients had a complete response with NACT alone, not undergoing surgery, and remained disease free at the study end. OS was 39.3 months (95% Confidence Interval (CI) 32.5 -Not reached (NR)) for the entire cohort and 40.1 months (95% CI 39.3 -NR) in the surgical group following median follow up of 27 months. Local recurrence was the predominant cause of failure. Conclusions: NACT followed by WLE is effective in a subgroup of patients with locally advanced vulval cancer and can minimize the extent of surgery necessary, but close monitoring is required to identify and manage relapse early.

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Radiation therapy of vulvar and vaginal cancer

Petersen,

Baehr,

Goy

et al. 2024

Onkologie

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Dose-escalated intensity modulated radiation therapy in patients with locally-advanced vulvar cancer - does it increase response rate?

Cited by 17 publications

References 16 publications

Lichen Sclerosis is Associated With a High Rate of Local Failure After Radio(chemo)therapy for Vulvar Cancer

Lichen Sclerosis is Associated With a High Rate of Local Failure After Radio(chemo)therapy for Vulvar Cancer

Retrospective cohort study of neoadjuvant chemotherapy followed by tailored surgery in locally advanced sphincter-threatening vulval cancer: an alternative to exenteration?

Radiation therapy of vulvar and vaginal cancer

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