Intensity modulated radiation therapy for squamous cell carcinoma of the vulva: Treatment technique and outcomes

Yuan James Rao, Anupama Chundury, Julie K. Schwarz, Comron Hassanzadeh, Todd DeWees, Daniel Mullen, Matthew A. Powell, David G. Mutch, Perry W. Grigsby

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objective The objective of this study was to present the treatment technique and evaluate clinical outcomes after intensity modulated radiation therapy (IMRT) for vulvar cancer. Methods and materials This retrospective study included 39 patients with squamous cell carcinoma of the vulva treated with IMRT from 2005 to 2015. There were 21 patients treated with postoperative IMRT, 13 with definitive IMRT, and 5 with preoperative IMRT. Tumor staging was Federation of Gynecology and Obstetrics stage I in 6, stage II in 7, stage III in 19, and stage IV in 7 patients. Concurrent chemotherapy was administered to 14 patients. Brachytherapy was delivered in 8 patients. Results The median follow-up was 34 months (range, 3.3-71). Median IMRT dose to patients receiving pre- or postoperative IMRT was 5040 cGy (range, 5040-6080). Median combined IMRT and brachytherapy dose to gross tumor was 7000 cGy (range, 5040-7520) in those treated with definitive RT. The 3-year locoregional control (LRC) and overall survival for those receiving postoperative RT were 89% and 67%, respectively. The 3-year LRC and overall survival for those receiving definitive IMRT were 42% and 49%, respectively. In patients receiving definitive or neoadjuvant IMRT, 69% had complete clinical response and 44% had complete pathologic response. The actuarial 3-year inguinal recurrence rate was 7%. There were no acute grade 3-4 hematological, gastrointestinal, or genitourinary toxicities. There were no late grade 3-4 gastrointestinal or genitourinary toxicities. Conclusions IMRT for vulvar cancer is associated with high rates of LRC in the postoperative setting and limited radiation-related toxicity. Durable LRC of disease after definitive IMRT remains challenging, and several refinements to our treatment technique are suggested.

Original languageEnglish (US)
Pages (from-to)148-158
Number of pages11
JournalAdvances in Radiation Oncology
Volume2
Issue number2
DOIs
StatePublished - Apr 1 2017
Externally publishedYes

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Vulva
Squamous Cell Carcinoma
Radiotherapy
Vulvar Neoplasms
Brachytherapy
Survival
Groin
Neoplasm Staging
Gynecology
Obstetrics
Retrospective Studies

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Intensity modulated radiation therapy for squamous cell carcinoma of the vulva : Treatment technique and outcomes. / Rao, Yuan James; Chundury, Anupama; Schwarz, Julie K.; Hassanzadeh, Comron; DeWees, Todd; Mullen, Daniel; Powell, Matthew A.; Mutch, David G.; Grigsby, Perry W.

In: Advances in Radiation Oncology, Vol. 2, No. 2, 01.04.2017, p. 148-158.

Research output: Contribution to journalArticle

Rao, YJ, Chundury, A, Schwarz, JK, Hassanzadeh, C, DeWees, T, Mullen, D, Powell, MA, Mutch, DG & Grigsby, PW 2017, 'Intensity modulated radiation therapy for squamous cell carcinoma of the vulva: Treatment technique and outcomes', Advances in Radiation Oncology, vol. 2, no. 2, pp. 148-158. https://doi.org/10.1016/j.adro.2017.02.006
Rao, Yuan James ; Chundury, Anupama ; Schwarz, Julie K. ; Hassanzadeh, Comron ; DeWees, Todd ; Mullen, Daniel ; Powell, Matthew A. ; Mutch, David G. ; Grigsby, Perry W. / Intensity modulated radiation therapy for squamous cell carcinoma of the vulva : Treatment technique and outcomes. In: Advances in Radiation Oncology. 2017 ; Vol. 2, No. 2. pp. 148-158.
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abstract = "Objective The objective of this study was to present the treatment technique and evaluate clinical outcomes after intensity modulated radiation therapy (IMRT) for vulvar cancer. Methods and materials This retrospective study included 39 patients with squamous cell carcinoma of the vulva treated with IMRT from 2005 to 2015. There were 21 patients treated with postoperative IMRT, 13 with definitive IMRT, and 5 with preoperative IMRT. Tumor staging was Federation of Gynecology and Obstetrics stage I in 6, stage II in 7, stage III in 19, and stage IV in 7 patients. Concurrent chemotherapy was administered to 14 patients. Brachytherapy was delivered in 8 patients. Results The median follow-up was 34 months (range, 3.3-71). Median IMRT dose to patients receiving pre- or postoperative IMRT was 5040 cGy (range, 5040-6080). Median combined IMRT and brachytherapy dose to gross tumor was 7000 cGy (range, 5040-7520) in those treated with definitive RT. The 3-year locoregional control (LRC) and overall survival for those receiving postoperative RT were 89{\%} and 67{\%}, respectively. The 3-year LRC and overall survival for those receiving definitive IMRT were 42{\%} and 49{\%}, respectively. In patients receiving definitive or neoadjuvant IMRT, 69{\%} had complete clinical response and 44{\%} had complete pathologic response. The actuarial 3-year inguinal recurrence rate was 7{\%}. There were no acute grade 3-4 hematological, gastrointestinal, or genitourinary toxicities. There were no late grade 3-4 gastrointestinal or genitourinary toxicities. Conclusions IMRT for vulvar cancer is associated with high rates of LRC in the postoperative setting and limited radiation-related toxicity. Durable LRC of disease after definitive IMRT remains challenging, and several refinements to our treatment technique are suggested.",
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T1 - Intensity modulated radiation therapy for squamous cell carcinoma of the vulva

T2 - Treatment technique and outcomes

AU - Rao, Yuan James

AU - Chundury, Anupama

AU - Schwarz, Julie K.

AU - Hassanzadeh, Comron

AU - DeWees, Todd

AU - Mullen, Daniel

AU - Powell, Matthew A.

AU - Mutch, David G.

AU - Grigsby, Perry W.

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N2 - Objective The objective of this study was to present the treatment technique and evaluate clinical outcomes after intensity modulated radiation therapy (IMRT) for vulvar cancer. Methods and materials This retrospective study included 39 patients with squamous cell carcinoma of the vulva treated with IMRT from 2005 to 2015. There were 21 patients treated with postoperative IMRT, 13 with definitive IMRT, and 5 with preoperative IMRT. Tumor staging was Federation of Gynecology and Obstetrics stage I in 6, stage II in 7, stage III in 19, and stage IV in 7 patients. Concurrent chemotherapy was administered to 14 patients. Brachytherapy was delivered in 8 patients. Results The median follow-up was 34 months (range, 3.3-71). Median IMRT dose to patients receiving pre- or postoperative IMRT was 5040 cGy (range, 5040-6080). Median combined IMRT and brachytherapy dose to gross tumor was 7000 cGy (range, 5040-7520) in those treated with definitive RT. The 3-year locoregional control (LRC) and overall survival for those receiving postoperative RT were 89% and 67%, respectively. The 3-year LRC and overall survival for those receiving definitive IMRT were 42% and 49%, respectively. In patients receiving definitive or neoadjuvant IMRT, 69% had complete clinical response and 44% had complete pathologic response. The actuarial 3-year inguinal recurrence rate was 7%. There were no acute grade 3-4 hematological, gastrointestinal, or genitourinary toxicities. There were no late grade 3-4 gastrointestinal or genitourinary toxicities. Conclusions IMRT for vulvar cancer is associated with high rates of LRC in the postoperative setting and limited radiation-related toxicity. Durable LRC of disease after definitive IMRT remains challenging, and several refinements to our treatment technique are suggested.

AB - Objective The objective of this study was to present the treatment technique and evaluate clinical outcomes after intensity modulated radiation therapy (IMRT) for vulvar cancer. Methods and materials This retrospective study included 39 patients with squamous cell carcinoma of the vulva treated with IMRT from 2005 to 2015. There were 21 patients treated with postoperative IMRT, 13 with definitive IMRT, and 5 with preoperative IMRT. Tumor staging was Federation of Gynecology and Obstetrics stage I in 6, stage II in 7, stage III in 19, and stage IV in 7 patients. Concurrent chemotherapy was administered to 14 patients. Brachytherapy was delivered in 8 patients. Results The median follow-up was 34 months (range, 3.3-71). Median IMRT dose to patients receiving pre- or postoperative IMRT was 5040 cGy (range, 5040-6080). Median combined IMRT and brachytherapy dose to gross tumor was 7000 cGy (range, 5040-7520) in those treated with definitive RT. The 3-year locoregional control (LRC) and overall survival for those receiving postoperative RT were 89% and 67%, respectively. The 3-year LRC and overall survival for those receiving definitive IMRT were 42% and 49%, respectively. In patients receiving definitive or neoadjuvant IMRT, 69% had complete clinical response and 44% had complete pathologic response. The actuarial 3-year inguinal recurrence rate was 7%. There were no acute grade 3-4 hematological, gastrointestinal, or genitourinary toxicities. There were no late grade 3-4 gastrointestinal or genitourinary toxicities. Conclusions IMRT for vulvar cancer is associated with high rates of LRC in the postoperative setting and limited radiation-related toxicity. Durable LRC of disease after definitive IMRT remains challenging, and several refinements to our treatment technique are suggested.

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