High-dose intensity-modulated chemoradiotherapy in vulvar squamous cell carcinoma: Outcome and toxicity

Rishi, Anupam; Rollins, Madeline; Ahmed, Kamran A.; Hunt, David E.; Sarkar, Papri; Fernandez, Daniel C.; Hoffman, Mitchel S.; Apte, Sachin M.; Shahzad, Mian M.K.; Chon, Hye Sook; Chern, Jing-Yi; Montejo, Michael

doi:10.1016/j.ygyno.2019.11.027

Cited by 23 publications

(34 citation statements)

References 22 publications

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“…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]. These results are in agreement with our study and together with GOG 101 and 205 suggest a doseeresponse relationship for vulvar cancer.…”

Section: Discussionsupporting

confidence: 89%

“…The impact of lichen sclerosis on outcome after radio(chemo)therapy has not been well investigated and most studies have not included this risk factor in their analysis [11e14, 17,18,23]. 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.…”

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: 89%

Section: Discussionmentioning

confidence: 99%

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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“…Another difference can be the type of chemotherapy. In most studies chemotherapy is cisplatinbased [28,30], cisplatin-5FU-based [9,29] or 5FU-based chemotherapy [27]. Our study is the first to report on oral-5FU (capecitabine) based chemotherapy in combination with radiotherapy.…”

Section: Discussionmentioning

confidence: 88%

“…Tans et al report grade 3 radiation ulcers in 4 patients, skin changes such as atrophy and fibrosis in 6 patients and a total percentage of long-term toxicity in 7 out of 28 patients (25%) [27]. Rishi et al [28] reported on grade 3-4 late toxicity in 5 out of 26 patients, with highgrade soft tissue toxicity in 3 patients. All four studies show a prevalence of toxicity that could really have impact on the quality of life of this patient group after this treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the efficacy of capecitabine remains unknown in comparison to a platinum regimen. Two studies with 26 and 28 patients included, reported on definitive chemoradiation, using chemotherapy schedules of 5FU/MMC and weekly cisplatin and high dose radiation with 60 Gy and 65.4 Gy, respectively [27,28]. The outcome data showed a cCR in 72% and locoregional control of 75% at 4 years [27] compared to a cCR in 80.7% and a 1-year local control rate of 72.4% [28].…”

Section: Discussionmentioning

confidence: 99%

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Phase II study of definitive chemoradiation for locally advanced squamous cell cancer of the vulva: An efficacy study

Triest¹,

Rasing

Velden

et al. 2021

Gynecologic Oncology

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Surgery for locally advanced vulvar cancer is often extensive with stoma formation or need for reconstructive surgery.• Definitive capecitabine-based chemoradiation is feasible with acceptable acute and late toxicity.• Local clinical complete response of 62% after 12 weeks and persistent local control of 42% after 2 years • Need for subsequent stoma formation in only 17% of patients.• Definitive chemoradiation can serve as alternative for extensive surgery in locally advanced vulvar cancer.

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Neoplasms of the Vulva and Vagina

Frumovitz¹,

Dewdney²

2022

Holland‐Frei Cancer Medicine

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Overview Vulvar and vaginal carcinomas are uncommon diseases that generally affect postmenopausal women, although 19% of vulvar carcinomas occur in women <50 years old. Risk factors for vulvar carcinoma include human papilloma virus and chronic inflammation. Vulvar intraepithelial neoplasia can often be managed with wide local excision, but several other modalities have been utilized. Most vulvar malignancies are squamous cell carcinomas that are managed by surgical excision and radiotherapy. Sentinel lymph node biopsy has been used to spare the morbidity observed after regional lymph node dissection. For more advanced lesions, chemo‐radiotherapy with agents such as 5‐FU, cisplatin, and mitomycin C is utilized. Other vulvar malignancies include Bartholin gland carcinomas, basal cell carcinomas, verrucous carcinomas, and melanomas. Carcinomas of the vagina are most frequently squamous cell, but clear cell adenocarcinomas have been seen in younger women. In the past, clear cell carcinomas were associated with pre‐natal exposure to diethylstilbestrol. Vaginal melanomas can occur, as well as endodermal sinus tumors, rhabdomyosarcomas, and fibroepithelial vaginal polyps.

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High-dose intensity-modulated chemoradiotherapy in vulvar squamous cell carcinoma: Outcome and toxicity

Cited by 23 publications

References 22 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

Phase II study of definitive chemoradiation for locally advanced squamous cell cancer of the vulva: An efficacy study

Neoplasms of the Vulva and Vagina

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