title: Exclusive radiotherapy for primary squamous cell carcinoma of the vagina.
abstract: OBJECTIVE
  To retrospectively analyze results of external beam therapy (EBT) with brachytherapy (BT) for primary vaginal squamous cell carcinoma (PVSCC).
  
  
  METHODS
  From 1970 to 2001, 91 patients were included. FIGO stages were: I (29%), II (38%), III (29%) and IVa (4%). EBT delivered a median total dose of 50 Gy to the pelvis. BT was performed with a customized intra-vaginal applicator and in 36% of applications combined endocavitary and interstitial BT. ICRU Report 38 parameters were reported.
  
  
  RESULTS
  The 5-year cause specific survival (CSS) rates were: 83% for stage I, 76% for stage II, 52% for stage III, and 2 of the 4 stage IVa patients died 9 and 36 months after treatment. The 5-year pelvis control rates were: 79% for stage I and II and 62% for stage III. Recurrences as a first event were local only in 68% of cases, nodal only in 10%, metastatic only in 13% and combined in 9%. In multivariate analysis: stage (I and II versus II and IV), response to EBT (evaluated at BT), and the number of BT applications were statistically significant for CSS. Grade 2-3 toxicities were as follows (Franco-Italian Glossary): rectum (n=3), sigmoid colon and small bowel (n=8), bladder (n=5), ureter (n=4) and vagina (n=13). Anterior location of the tumor increased bladder toxicity (p=0.01) and total reference air kerma was higher in patients who experienced grade 2-3 urinary or digestive toxicity (p=0.03).
  
  
  CONCLUSIONS
  EBT with BT is an effective treatment for patients with stage I-II PVSCC. The incidence and severity of late toxicity were relatively low. Recent advances in the treatment of cervix carcinoma emphasize the need for concomitant radio-chemotherapy in stages III-IV and the use of MRI for treatment planning.
authors.affiliation: Department of Radiation Oncology, Institut Gustave-Roussy, 39 rue Camille Desmoulins, Villejuif, France. rdecrevoisier@yahoo.fr
authors.forename: Renaud
authors.initials: R
authors.lastname: de Crevoisier
authors.forename: Nicholas
authors.initials: N
authors.lastname: Sanfilippo
authors.forename: Alain
authors.initials: A
authors.lastname: Gerbaulet
authors.forename: Philippe
authors.initials: P
authors.lastname: Morice
authors.forename: Christophe
authors.initials: C
authors.lastname: Pomel
authors.forename: Damiene
authors.initials: D
authors.lastname: Castaigne
authors.forename: Patricia
authors.initials: P
authors.lastname: Pautier
authors.forename: Catherine
authors.initials: C
authors.lastname: Lhomme
authors.forename: Pierre
authors.initials: P
authors.lastname: Duvillard
authors.forename: Christine
authors.initials: C
authors.lastname: Haie-meder
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D011878:Radiotherapy / Q000009:adverse effects; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D015996:Survival Rate; D014625:Vaginal Neoplasms / Q000401:mortality / Q000532:radiotherapy*