This treatment schema provided excellent tolerance with sustained local control. All patients obtained cCR and were able to avoid pelvic exenteration surgery and maintain preservation of bladder and rectal function.
Melissa Joyner, MD, Gwyn Richardson, MD, Lyuba Levine, Sandra Hatch; UT Medical Branch, Galveston
OBJECTIVES: To review historical use of preoperative chemoradiotherapy at a single institution in patients with locally advanced vulvar cancer who were not surgical candidates due to extent of disease. Patients were treated with intent to improve local control with organ preservation.
METHODS: Historical chart review of 12 patients with an average age of 52 years (range: 40–72 yr) treated between 1997 and 2014, all with locally advanced clinical stage T3 or T4 squamous cell carcinomas of the vulva not amenable to surgical resection. A total of 2 of 12 patients presented with locally advanced recurrent disease and nodal relapse. All patients were treated with external beam to 4,760 cGy (1.7 Gy per fraction × 28 fractions) using an accelerated fractionation schema consistent with the Gynecologic Oncology Group (GOG) 101 protocol with a planned treatment break in conjunction with concurrent cisplatin and 5-fluorouracil (5-FU). A single patient treated with a modified fractionation schema after the first cycle of radiation demonstrated superior treatment response, which facilitated surgical resection; this patient was then followed with additional radiation to treat residual microscopic disease. Further, 7 out of 12 patients (58.3%) also received a boost ranging from 7.2 Gy to 17.2 Gy, with a single patient receiving 12 Gy standard deviation [SD] via vaginal cylinder.
RESULTS: The study patients had an average of 75 months of follow-up. Sustained local control was achieved in 8 of 12 patients (66.7%). A complete clinical response (cCR) was seen in 100% of patients following treatment. Despite extensive disease at presentation, only 2 of 12 patients (16.7%) failed in the vulva. A significant number of patients remained disease-free with no evidence of distant metastases (58%)-5 of 12 patients were alive without any disease, and an additional 2 of 12 expired without evidence of disease. While 2 out of 12 patients exhibited evidence of active disease, they are alive and undergoing additional therapy. Only 2 of 12 patients to date have expired with evidence of disease, and 1 patient expired with disease status unknown. Biopsies only were done of the primary and/or node in 4 of 12 patients (33%), which were negative for disease. Organ preservation was achieved in 100% of patients.
CONCLUSIONS: This treatment schema provided excellent tolerance with sustained local control. All patients obtained cCR and were able to avoid pelvic exenteration surgery and maintain preservation of bladder and rectal function.
Proceedings of the 97th Annual Meeting of the American Radium Society- americanradiumsociety.org