title: Preoperative intensity modulated radiation therapy and chemotherapy for locally advanced vulvar carcinoma: analysis of pattern of relapse.
abstract: OBJECTIVE
  To examine clinical outcomes and relapse patterns in locally advanced vulvar carcinoma treated using preoperative chemotherapy and intensity modulated radiation therapy (IMRT).
  
  
  METHODS
  Forty-two patients with stage I-IVA (stage I, n=3; stage II, n=13; stage III, n=23; stage IVA, n=3) vulvar cancer were treated with chemotherapy and IMRT via a modified Gynecological Oncology Group schema using 5-fluorouracil and cisplatin with twice-daily IMRT during the first and last weeks of treatment or weekly cisplatin with daily radiation therapy. Median dose of radiation was 46.4 Gy.
  
  
  RESULTS
  Thirty-three patients (78.6%) had surgery for resection of vulva; 13 of these patients also had inguinal lymph node dissection. Complete pathologic response was seen in 48.5% (n=16) of these patients. Of these, 15 had no recurrence at a median time of 26.5 months. Of the 17 patients with partial pathological response, 8 (47.1%) developed recurrence in the vulvar surgical site within a median of 8 (range, 5-34) months. No patient had grade ≥3 chronic gastrointestinal/genitourinary toxicity. Of those having surgery, 8 (24.2%) developed wound infections requiring debridement.
  
  
  CONCLUSIONS
  Preoperative chemotherapy/IMRT was well tolerated, with good pathologic response and clinical outcome. The most common pattern of recurrence was local in patients with partial response, and strategies to increase pathologic response rate with increasing dose or adding different chemotherapy need to be explored to help further improve outcomes.
authors.affiliation: Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania, USA. beriwals@upmc.edu
authors.forename: Sushil
authors.initials: S
authors.lastname: Beriwal
authors.forename: Gaurav
authors.initials: G
authors.lastname: Shukla
authors.forename: Ashwin
authors.initials: A
authors.lastname: Shinde
authors.forename: Dwight E
authors.initials: DE
authors.lastname: Heron
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Kelley
authors.forename: Robert P
authors.initials: RP
authors.lastname: Edwards
authors.forename: Paniti
authors.initials: P
authors.lastname: Sukumvanich
authors.forename: Scott
authors.initials: S
authors.lastname: Richards
authors.forename: Alexander B
authors.initials: AB
authors.lastname: Olawaiye
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Krivak
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods*; D002945:Cisplatin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D007264:Inguinal Canal; D008197:Lymph Node Excision; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D018365:Neoplasm, Residual; D011300:Preoperative Care; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated; D013530:Surgical Wound Infection / Q000601:surgery; D016896:Treatment Outcome; D014846:Vulvar Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*
chemical_list: D002945:Cisplatin; D005472:Fluorouracil