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Primary invasive carcinoma of the vagina
Author(s) -
Tewari Krishnansu S.,
Cappuccini Fabio,
Puthawala Ajmel A.,
Kuo Jeffrey V.,
Burger Robert A.,
Monk Bradley J.,
Manetta Alberto,
Berman Michael L.,
Disaia Philip J.,
Syed A. M. Nisar
Publication year - 2001
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(20010215)91:4<758::aid-cncr1062>3.0.co;2-u
Subject(s) - medicine , stage (stratigraphy) , surgery , radiation therapy , vagina , implant , carcinoma , external beam radiotherapy , brachytherapy , paleontology , biology
BACKGROUND Because primary carcinoma of the vagina comprises less than 2% of all gynecologic malignancies, the reported experience in the treatment of large numbers of patients is available only from a few major centers and most often encompasses a variety of differences in treatment selection and technique. The objective of this study was to assess the long term results of an interstitial iridium‐192 afterloading implant technique using the Syed‐Neblett dedicated vaginal plastic template. METHODS Patients who were treated from 1976 to 1997 were examined retrospectively. RESULTS Seventy‐one patients underwent interstitial implantation with (n = 61 patients) or without external beam radiotherapy. The median age was 59 years (range, 16–86 years). Patients were staged according to the International Federation of Gynecology and Obstetrics system and included Stage I (n = 10 patients), Perez modification Stage IIA (n = 14 patients), Perez modification Stage IIB (n = 25 patients), Stage III (n = 15 patients), and Stage IV (n = 7 patients). Each implant delivered an approximately 20‐gray (Gy) minimum tumor dose, with the total tumor dose reaching 80 Gy with integrated external beam radiotherapy. Local control was achieved in 53 patients (75%). The median follow‐up was 66 months (range, 15–163 months), and the 2‐year, 5‐year, and 10‐year actuarial disease free survival rates are 73%, 58%, and 58%, respectively. By stage, 5‐year disease free survival rates included Stage I, 100% of patients; Stage IIA, 60% of patients; Stage IIB, 61% of patients; Stage III, 30% of patients; and Stage IV, 0% of patients. The factors disease stage and primary lesion size independently influenced the survival rates. Significant complications occurred in 9 patients (13%) and included necrosis (n = 4 patients), fistulae (n = 4 patients), and small bowel obstruction (n = 1 patient). CONCLUSIONS Interstitial irradiation can effect local control in the majority of patients with primary carcinoma of the vagina with acceptable morbidity. Long term cure is demonstrable in patients with Stage I–III disease. Cancer 2001;91:758–70. © 2001 American Cancer Society.