International Journal of Radiation Oncology*Biology*Physics
Clinical investigationsVaginaDefinitive radiation therapy for squamous cell carcinoma of the vagina
Introduction
Vaginal carcinomas are rare, comprising only 2% of gynecologic malignancies. Treatment of vaginal carcinomas poses special challenges to the multidisciplinary team, because the techniques used to treat them are highly specialized and because the distribution of disease in the vagina and paravaginal tissues has an important influence on the type of treatment needed to obtain the best results. Because of the vagina’s close proximity to critical structures, cancers arising in this area are rarely amenable to curative organ-sparing surgery; fortunately, radiation therapy is an effective treatment and is currently used to treat most patients with invasive vaginal cancers.
The rarity of vaginal cancer makes it a difficult subject for study. To our knowledge, there have been no prospective randomized trials of vaginal cancer treatment. Most retrospective studies have been small or have included patients who had rare, nonsquamous cancers or a previous history of treatment for cervical or other gynecologic malignancies. During the last 50 years, there have been several retrospective reviews of the experience with vaginal cancer at The University of Texas M. D. Anderson Cancer Center (1, 2, 3, 4, 5). Most recently, Chyle et al. (3) reported results of radical radiation therapy in patients treated between 1953 and 1991. Although that series was relatively large, it included patients treated before high-energy accelerators were available and patients who had in situ disease or adenocarcinoma or presented with a previous history of invasive cervical cancer. The purpose of this report is to update our institutional experience, focusing on patients with primary invasive squamous cell carcinoma of the vagina who had not previously been treated for gynecologic malignancies, and to suggest guidelines for treatment of these rare cancers.
Section snippets
Patients
The medical records, including clinical notes and tumor diagrams, of all patients treated with definitive radiation therapy for primary invasive squamous cell carcinoma of the vagina at M. D. Anderson Cancer Center between January 1970 and December 2000 were reviewed retrospectively. Patients whose tumors involved the vulva or extended to the external os of the cervix were excluded (6). Patients who had noninvasive carcinoma of the vagina (i.e., in situ disease) or nonsquamous histologic
Patient and tumor characteristics
The pretreatment characteristics of the 193 patients included in this analysis are summarized in Table 3. The median age was 61 years (range, 31–92 years). The most common presenting symptom was vaginal bleeding, which was present in 104 patients (54%); 39 patients (20%) presented with vaginal discharge, and 30 patients (16%) presented with vaginal pain or dyspareunia. One hundred twenty-one patients (63%) had had a previous hysterectomy for benign or preinvasive disease (20%); the most common
Discussion
This report describes the largest single-institution study of definitive radiation therapy for patients with invasive squamous cell carcinoma of the vagina without a prior history of an invasive gynecologic malignancy. Although other authors (1, 2, 3, 4, 5) have described results of radiation therapy in patients treated with radiation for vaginal cancer, the small size and heterogeneity of their study populations have often made it difficult to generalize their conclusions to current practice.
References (26)
- et al.
Definitive radiotherapy for carcinoma of the vaginaOutcome and prognostic factors
Int J Radiat Oncol Biol Phys
(1996) - et al.
Primary squamous cell carcinoma of the vagina treated by radiotherapyA failure analysis—The M.D. Anderson Hospital experience 1955–1982
Int J Radiat Oncol Biol Phys
(1988) Cancer of the vagina
Am J Obstet Gynecol
(1967)- et al.
Treatment of extensive carcinoma of the cervix with the “transperineal parametrial butterfly”A preliminary report on the revival of Waterman’s approach
Int J Radiat Oncol Biol Phys
(1978) - et al.
CTCAE v.3.0Development of a comprehensive grading system for the adverse effects of cancer treatment
Semin Radiat Oncol
(2003) - et al.
Radiation therapy of primary vaginal carcinoma
Int J Radiat Oncol Biol Phys
(1983) - et al.
Results of radiotherapeutic management of primary carcinoma of the vagina
Int J Radiat Oncol Biol Phys
(1991) - et al.
Factors affecting long-term outcome of irradiation in carcinoma of the vagina
Int J Radiat Oncol Biol Phys
(1999) - et al.
Primary carcinoma of the vaginaTATA Memorial Hospital experience
Int J Radiat Oncol Biol Phys
(2000) - et al.
Carcinoma of the vagina—experience at the Princess Margaret Hospital (1974–1989)
Gynecol Oncol
(1995)
A 30-year experience in the management of primary carcinoma of the vaginaAnalysis of prognostic factors and treatment modalities
Gynecol Oncol
Irradiation of ‘in-situ’ and invasive squamous cell carcinoma of the vagina
Cancer
Radiotherapeutic management of malignant tumors of the vagina
AJR Am J Roentgenol
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