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Vienna, Austria

ESTRO 2023

Session Item

Gynaecological
6014
Poster (Digital)
Clinical
intensity modulated radiotherapy in vulvar cancer: results from an observational single-center study
Erika Galietta, Italy
PO-1423

Abstract

intensity modulated radiotherapy in vulvar cancer: results from an observational single-center study
Authors:

Daria Vallerossa1,2, Andrea Galuppi3, Anna Benini4, Erika Galietta4, Letizia Cavallini4, Milly Buwenge4, Gabriella Macchia5, Savino CIlla6, Silvia Cammelli7, Fabrizio Romani8, Lidia Strigari8, Alessio Giuseppe Morganti1, Martina Ferioli1

1Radiation Oncology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; 2Radiation Oncology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; 3IRCCS Azienda Ospedaliero-Universitaria di Bologna, Radiation Oncology Unit, Bologna, Italy; 4 Radiation Oncology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; 5Università Cattolica del Sacro Cuore, Radiation Oncology Unit, Gemelli Molise Hospital, Campobasso, Italy; 6Fondazione Policlinico Universitario A. Gemelli, IRCCS, Medical Physics, Gemelli Molise Hospital, Campobasso, Italy; 7 Radiation Oncology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; 8IRCCS Azienda Ospedaliero-Universitaria di Bologna, Medical Physics, Bologna, Italy

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Purpose or Objective

Radiotherapy (RT) of vulvar cancer (VC) is a treatment option in both patients with advanced disease and in the adjuvant setting. Intensity Modulated RT (IMRT) and Volumetric Modulated Arc Therapy (VMAT) enable more conformal dose distribution and the delivery of higher doses to the target and lower doses to organs at risk. Here we report the results from an observational study on clinical outcome and toxicity in VC patients treated in our center with IMRT/VMAT

Material and Methods

Vulvar cancer patients who underwent adjuvant or definitive IMRT or VMAT in our institution were included in this analysis. Toxicity, local control (LC), overall survival (OS), progression free survival and pattern of recurrence were evaluated.

Results

Forty-one patients were included. Median age was 77 years (range 46-93). Most patients were treated with IMRT, from 2016 to 2021. Adjuvant RT was delivered in 41.5% patients and definitive RT in 58.5%. The delivered RT dose to the vulva in the adjuvant and definitive settings ranged between 39.6–65 Gy and 32.4-66 Gy, respectively, while the dose to the inguinal nodes was 45-65 Gy and 32.4-66 Gy, respectively. Moreover, 48.8% of patients were treated for locally recurrent VC. Concurrent chemotherapy was used in 18 patients (44.0%). Most patients showed grade 2 (22%) or 3 (73.2%) skin acute toxicity while gastrointestinal and genitourinary toxicity affected fewer patients and with lower grades of severity. Treatment was not completed in 4.9% of patients. One- and 2-year LC was 68.3% and 55.7%, respectively, with better results in the adjuvant setting (two-year LC 67.9%). Two-year OS was 52.5 and 27.4% in patients treated with adjuvant and definitive RT, respectively (Figure 1), with a statistically significant difference (p 0.019).  

Conclusion

Vulvar cancer is a rare disease and most of available evidence is based on retrospective studies. Clinical outcome was not satisfactory in our patients, especially in those treated for local recurrence after previous surgery. Despite IMRT allows improved dose distribution, our data suggests that in an elderly population it is difficult to complete treatment without interruptions and to achieve satisfactory clinical outcomes. Moreover, skin toxicity remains an important limitation to deliver a high RT dose.