title: Definitive radiotherapy for treatment of primary vaginal cancer: effectiveness and prognostic factors.
abstract: OBJECTIVE
  This study was performed to evaluate treatment outcomes and define prognostic factors for primary vaginal cancer treated with definitive radiotherapy.
  
  
  METHODS
  We retrospectively analyzed 38 patients with primary vaginal cancer who received radiotherapy with curative intent between January 1981 and August 2008. Of these 38 patients, 6 were excluded from this analysis because of other uncontrolled malignancy (n = 1), uncommon histology (n = 4), or insufficient medical records (n = 1). Twenty-three patients (72%) presented with early-stage disease (International Federation of Gynecology and Obstetrics stages 0, I, or II). Eleven patients (34%) were treated with external beam radiotherapy (EBRT) alone and 21 patients (66%) with EBRT plus brachytherapy (BT). Low-dose rate cesium-137 was used with intracavitary technique for most of the patients who received BT. Five patients received chemotherapy. The median total dose in patients who received EBRT and EBRT+BT was 50.4 Gy (range, 39.6-70.4 Gy) and 78.9 Gy (range, 72.0-87.0 Gy), respectively.
  
  
  RESULTS
  The median duration of follow-up was 38 months. Five-year overall survival, cause-specific survival, disease-free survival, local control, and regional control rates for the analyzed patients were 75%, 88%, 58%, 62% and 90%, respectively. Thirteen patients had treatment failure as follows: local (n = 7), distant (n = 1), local plus regional (n = 1), local plus distant (n = 2), and local plus regional plus distant (n = 2). Primary tumor size was a significant prognostic factor for disease-free survival (P = 0.039).
  
  
  CONCLUSIONS
  Definitive radiotherapy is an effective treatment modality for primary vaginal cancer. Local failure was the major failure pattern, and achievement of local control is important for disease control and survival.
authors.affiliation: Department of Radiation Oncology, Medical Research Center, Seoul National University, Seoul, Republic of Korea.
authors.forename: Won Il
authors.initials: WI
authors.lastname: Jang
authors.forename: Hong-Gyun
authors.initials: HG
authors.lastname: Wu
authors.forename: Sung Whan
authors.initials: SW
authors.lastname: Ha
authors.forename: Hak Jae
authors.initials: HJ
authors.lastname: Kim
authors.forename: Soon Beom
authors.initials: SB
authors.lastname: Kang
authors.forename: Yong Sang
authors.initials: YS
authors.lastname: Song
authors.forename: Noh-Hyun
authors.initials: NH
authors.lastname: Park
authors.forename: Jae Weon
authors.initials: JW
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis; D002277:Carcinoma / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D012074:Remission Induction / Q000379:methods; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014625:Vaginal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy*
chemical_list: D014408:Biomarkers, Tumor