(P021) Delivery and Outcomes of Adjuvant Radiation Therapy in Older Women With Node-Positive Vulvar Cancer

Publication
Article
OncologyOncology Vol 30 No 4_Suppl_1
Volume 30
Issue 4_Suppl_1

In this cohort of older women with node-positive vulvar cancer, adjuvant RT is associated with improved OS, though overall outcomes are poor. More reliable delivery of quality RT may further improve survival in this population.

Cameron W. Swanick, MD, Grace L. Smith, MD, PhD, MPH, Jinhai Huo, PhD, MD, MPH, Larissa A. Meyer, MD, Patricia J. Eifel, MD; UT MD Anderson Cancer Center

PURPOSE: We examined postoperative radiation therapy (RT) use, clinical outcomes, and indicators of the quality of RT delivered in vulvar cancer patients with node-positive disease.

METHODS: Using the Surveillance, Epidemiology, and End Results–Medicare linked database, we identified 519 patients (aged ≥ 66 yr) with nonmetastatic node-positive vulvar cancer treated with primary surgery from 1991–2009. Procedure claims identified adjuvant RT. We tested associations between RT use and overall survival (OS) as well as cause-specific survival (CSS) using proportional hazards regression. Among patients treated with RT, we described benchmarks of quality based on: (1) treatment completion of ≥ 20 fractions; (2) treatment duration < 8 weeks; (3) no treatment break > 5 days per 12 elapsed days; and (4) no RT delay, based on the interval from surgery to start of treatment of < 8 weeks.

RESULTS: Sixty-seven percent of patients (n = 349) received adjuvant RT. On multivariable analysis, RT was associated with improved OS compared with surgery alone (hazard ratio [HR], 0.71 [95% CI, 0.57–0.88]; P = .002), with a trend toward improved CSS (HR, 0.79 [95% CI, 0.59–1.05]; P = .11). OS and CSS were improved in patients who received ≥ 20 fractions (3-year OS: 34% vs 26%, P = .008; 3-year CSS: 48% vs 37%, P = .03). There were absolute, but not significant, improvements in OS and CSS in patients who completed RT in < 8 weeks (3-year OS: 33% vs 27%, P = .13; 3-year CSS: 46% vs 39%, P = .10) and had < 5 days of treatment break per 12 elapsed days (3-year OS: 31% vs 29%, P = .84; 3-year CSS: 48% vs 38%, P = .24). An interval from surgery to RT of < 8 weeks was not associated with improved outcomes. Only 23% of patients who received RT met all four benchmarks.

CONCLUSIONS: In this cohort of older women with node-positive vulvar cancer, adjuvant RT is associated with improved OS, though overall outcomes are poor. More reliable delivery of quality RT may further improve survival in this population. 

Proceedings of the 98th Annual Meeting of the American Radium Society - americanradiumsociety.org

Articles in this issue

(S002) A 15-Year Review of Radiation Therapy for Keloids at Two Institutions
(S003) Single-Fraction Radiation Therapy for the Treatment of Multiple Myeloma Bony Metastases Provides Pain Control and Decreases Time to Chemotherapy
(S001) Prognostic Value of Pretreatment Serum Inflammatory Markers in Patients Receiving Radiation Therapy for Oropharyngeal Cancer
(S004) Trend in Second Malignancy Risk for Head and Neck Cancer With Increased Utilization of IMRT: Analysis of SEER Database
(S005) Comparison of Legal Needs of a Group of Patients With Cancer: Economic and Geographic Factors
(S006) Mission Improvement: Lessons From Initiating a Resident-Led Quality Improvement Project on Smoking Cessation at a County Hospital
(S007) Results of a Phase II Trial Using Cetuximab Plus Docetaxel With Low-Dose Fractionated Radiation for Recurrent Unresectable Locally Advanced Head and Neck Carcinoma
(S008) The Effect of Simulation and Treatment Delays for Patients With Oropharyngeal Cancer Receiving Definitive Radiation Therapy in the Era of Risk Stratification Using Smoking and Human Papilloma Virus Status
(S009) Intensity-Modulated Radiation Therapy With Stereotactic Body Radiation Therapy Boost for Unfavorable Prostate Cancer: A Report on Three-Year Toxicity
(S011) Comparative Study Between Ileal Conduit and Indiana Pouch After Cystectomy for Patients With Carcinoma of Urinary Bladder
(S010) Computed Tomography–Assessed Measures of Bone Mineral Density and Muscle Mass as Predictors of Survival in Men With Prostate Cancer
(S012) Quantitative Imaging to Evaluate the Malignant Potential of Pancreatic Cysts
(S013) Spine Stereotactic Radiosurgery With Concurrent Tyrosine Kinase Inhibitors for Metastatic Renal Cell Carcinoma
(S014) The Impact of Radiation Therapy on Survival in Surgically Resected, High-Risk Patients With Ampullary Adenocarcinoma: A Population-Based Analysis
(S016) The Impact of Stereotactic Body Radiation Therapy on Overall Survival in Patients With Locally Advanced Pancreatic Cancer
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