title: Prognostic factors for outcomes and complications for primary squamous cell carcinoma of the vagina treated with radiation.
abstract: OBJECTIVE
  To analyze the results of treatment and identify prognostic factors for primary squamous cell carcinoma (SCCA) of the vagina managed with radiotherapy at a single institution.
  
  
  METHODS
  Seventy-eight patients were analyzed in this retrospective series. Mean characteristics: follow-up 89 months; age 65 years (range 33-99); tumor size 3.8 cm (0.3-10); treatment hemoglobin 12.4 g/dl (range 8.7-14.4); and tumor dose 72 Gy (range 6-127). In addition, 49% of our cohort had a prior hysterectomy. The FIGO stage distribution: I (42%); II (29%); III (17%); and IVA/B (11%). Sixty-two percent of patients were treated with a combination of external beam radiation (EBRT) and brachytherapy, 22% with EBRT alone and 13% with brachytherapy alone.
  
  
  RESULTS
  Kaplan-Meier (KM) 5-year pelvic control, distant metastasis free survival and disease specific survival probabilities: stage I, 83%, 100%, and 92%; stage II, 76%, 95%, and 68%; stage III, 62%, 65%, and 44%; and stage IV, 30%, 18%, and 13%. On multivariate analysis: stage; treatment hemoglobin; and prior hysterectomy were prognostic for DSS (p<0.05). The KM 5-year grade 3/4 (G3/4) complication free estimate of our cohort was 84%. G3/4 complications: tumor size and tumor dose were independently predictive (p<0.05).
  
  
  CONCLUSIONS
  Radiotherapy as a single modality for early stage primary vaginal SCCA produces good results. Advanced stage disease necessitates a combined modality approach and/or new methods. Treatment Hg levels appear to be clinically significant and studies on correction of anemia during treatment are warranted.
authors.affiliation: Department of Radiation Oncology, Stanford Cancer Center, 875 Blake Wilbur Drive, Stanford, CA 94305, USA.
authors.forename: Phuoc T
authors.initials: PT
authors.lastname: Tran
authors.forename: Zheng
authors.initials: Z
authors.lastname: Su
authors.forename: Percy
authors.initials: P
authors.lastname: Lee
authors.forename: Philip
authors.initials: P
authors.lastname: Lavori
authors.forename: Amreen
authors.initials: A
authors.lastname: Husain
authors.forename: Nelson
authors.initials: N
authors.lastname: Teng
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Kapp
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D016896:Treatment Outcome; D014625:Vaginal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery