Session Item

To evaluate clinical outcomes after definitive radiotherapy (RT) for carcinoma of the vulva.

Single center retrospective analysis of women diagnosed with vulvar carcinoma between January 2013 to December 2019 treated with definitive RT.
3-year overall survival (OS), progression-free survival (PFS),were calculated using Kaplan-Meier method and the cumulative incidence of local, inguinal and distant relapse was calculated using competing risk models considering death without prior recurrence as a competing event.
The association of concomitant chemotherapy and interruption of RT with OS and PFS was evaluated using Cox proportional hazards regression controlling for the confounding variables, age at diagnosis, disease stage and HIV infection. These confounding variables were defined a priori based on clinical criteria. We considered a significance level of 5%. Acute toxicity was assessed according to the Common Terminology Criteria for Adverse Events v 5.

Eighty-one women were included. Median follow-up was 60 months (5 years). Median age at diagnosis was 78 years (range 42-95), squamous cell carcinoma (SCC) was the most frequent histology (n=70, 98%). FIGO 2009 stage were II 31%, III 35%, IVA 13% and IVB 20%.
All patients were treated with intensity modulated radiotherapy (IMRT). Median dose to primary tumor was 70 Gy (36-70). Thirty-five patients received concurrent chemotherapy, most commonly cisplatin + 5FU (80%).
Median total treatment time of RT was 55 days (25-133), 13 patients (16%) interrupted RT treatment due to worsening of clinical status or skin toxicity.
Skin toxicity was the most common acute toxicity, G3 37(46%) and G4 2(2%). There were no acute G3 or G4 gastrointestinal or genitourinary toxicity.
The 3-year cumulative incidence of local recurrence was 33.3%, inguinal and distant recurrence were 7.4%.
Median OS and PFS were 12.1 (95%CI, 10.3-15.1) and 6.8 months (95% CI, 5.7-10.3), respectively. The 3-year OS was 14.8% (95%CI, 8.8%-25%) and PFS was 9.9% (95% CI, 5.1%-19.1%).
Multivariable analyses showed a significant deleterious effect of interruption of RT on OS (HR=2.17; 95% CI, 1.15-4.0; P=0.016) and in PFS (HR=2.48; 95%CI 1.31-4.69; P=0.005). Conversely, concomitant chemotherapy had a beneficial effect on OS, although not statistically significant (HR=0.52; 95%CI, 0.98-1.05; P=0.09), and on PFS (HR=0.48; 95%CI 0.24-0.97; P=0.04).

Definitive RT for advanced vulvar carcinoma is associated with acceptable rates of locoregional control and treatment-related toxicity.
Interruption of RT treatment was significantly associated with decreased OS and PFS. Concomitant chemotherapy seems to be associated with increased OS and with increased PFS.