Treatment outcomes of curative radiotherapy in patients with vulvar cancer: results of the retrospective KROG 1203 study

Abstract

PurposeWe evaluated the prognostic factors and clinical outcomes of 56 patients with vulvar cancer treated with curative radiotherapy (RT) or concurrent chemoradiotherapy.Materials and MethodsOverall survival (OS) and disease-free survival (DFS) were assessed retrospectively. Prognostic factors evaluated included age, International Federation of Gynecology and Obstetrics (FIGO) stage, TNM classification, tumor size, treatment modality, RT duration, and RT field. The association between the tumor human papillomavirus (HPV) status and survival was analyzed in 35 patients.ResultsDuring the median follow-up of 2.8 years (range, 0.3 to 18.9 years), 21 patients (37.5%) experienced treatment failure. Fifteen patients (27%) had local failure: nine (16%) local failure only, three (5%) locoregional failure, two (4%) local and distant failure, and one (2%) locoregional and distant failure. Of 56 patients, seven (13%) had persistent disease at the first follow-up at 2 months and all but one died within a year after completing RT. The 5-year OS and DFS were 51.6% and 44.0%, respectively. In multivariate analysis, clinical size ≥3 cm predicted a poor prognostic factor for DFS (p = 0.040) and age (≥70 years) was poor prognostic for DFS (p = 0.032) and OS (p = 0.048). Patients with HPV-positive tumors tended to have better 5-year OS and DFS, but the differences were not significant statistically.ConclusionClinical size ≥3 cm was a significant prognostic factor for DFS. However, age was the most important prognostic factor for DFS and OS in patients treated with curative RT. Further studies are needed to determine which treatment should be considered for old age ≥70 years.

Does HPV status influence survival after vulvar cancer?

“…31,41,42,44,46 Additionally, two studies were from Brazil 33,39 and one study was conducted in Korea. 40 The age of the included women were similar in all studies, with reported age means or medians ranging from early 60s to early 70s. Fifteen studies 30,[32][33][34][35][36][37][38][39][41][42][43][44][45][46] included only women with vulvar SCCs.…”

“…The majority of studies originated from Europe ( n = 10) and USA or Canada ( n = 5) . Additionally, two studies were from Brazil and one study was conducted in Korea . The age of the included women were similar in all studies, with reported age means or medians ranging from early 60s to early 70s.…”

“…The majority of studies ( n = 15) used formalin‐fixed paraffin‐embedded tissue samples for diagnosis and HPV testing. Most studies ( n = 14) used polymerase chain reaction (PCR)‐based test to detect HPV DNA, while two studies used in situ hybridization (ISH) and one study used hybrid capture 2 (HC2). Finally, one study used p16 immunohistochemistry (p16 IHC) as a surrogate marker for HPV infection …”

“…Previous studies have been limited by small study populations, but in this meta‐analysis, we combined the power of numerous studies comprising a total of 1,638 women with HPV tested vulvar cancer, which provided more precise estimates of effects. Among the 18 included studies, only three included other histological types than vulvar SCC, with the proportion of SCC amounting to 86%, 96% and 98%, respectively. However, our study also has some limitations.…”

“…Fifteen studies 30,[32][33][34][35][36][37][38][39][41][42][43][44][45][46] included only women with vulvar SCCs. Among the three studies that included vulvar cancers of various histology the proportions of SCC were 86%, 29 96% 31 and 98%, 40 respectively. Fourteen studies [31][32][33][34][36][37][38][39][40][42][43][44][45][46] included women with vulvar carcinomas of FIGO stage I-IV, one study included FIGO stage I-III 29 and another study only included FIGO stage I.…”