title: Patterns of care for locally advanced vulvar cancer.
abstract: OBJECTIVE
  Patients with locally advanced vulvar carcinoma can be treated with primary surgery or neoadjuvant chemoradiation. Neoadjuvant treatment appears to be associated with decreased morbidity and acceptable long-term outcomes. We examined the patterns of care for women with locally advanced vulvar cancer.
  
  
  METHODS
  Data from the Surveillance, Epidemiology, and End Results (SEER) database was used to examine women with stage III-IVA vulvar cancer treated from 1988 to 2008. Primary therapy was classified as surgery or radiation. Multivariable logistic regression models were developed to examine the use of primary radiotherapy.
  
  
  RESULTS
  We identified a total of 2292 women including 1757 who underwent primary surgery (76.7%) and 535 treated with primary radiation (23.3%). The use of primary radiation increased with time from 18.0% in 1988 to 30.1% in 2008. In a multivariable model, older women (odds ratio [OR], 1.33; 95% confidence interval [CI], 1.03-1.72), black women (OR, 1.59; 95% CI, 1.14-2.23), and patients with stage IVA tumors (OR, 2.23; 95% CI, 1.78-2.81) were more likely to receive primary radiation. Among women treated with primary radiotherapy, only 17.8% ultimately underwent surgical resection.
  
  
  CONCLUSIONS
  The use of primary radiation for locally advanced vulvar cancer is limited but has increased over time. Multiple patient and tumor factors influence use. The majority of patients with stage III-IVA vulvar cancer treated with primary radiation therapy did not undergo surgical resection.
authors.affiliation: Department of Radiation Oncology, College of Physicians and Surgeons, Columbia University, New York, NY.
authors.forename: Charu
authors.initials: C
authors.lastname: Sharma
authors.forename: Israel
authors.initials: I
authors.lastname: Deutsch
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Herzog
authors.forename: Yu-Shiang
authors.initials: YS
authors.lastname: Lu
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Neugut
authors.forename: Sharyn N
authors.initials: SN
authors.lastname: Lewin
authors.forename: Clifford K
authors.initials: CK
authors.lastname: Chao
authors.forename: Dawn L
authors.initials: DL
authors.lastname: Hershman
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wright
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D011878:Radiotherapy / Q000706:statistics & numerical data* / Q000639:trends; D018426:SEER Program; D014481:United States; D014846:Vulvar Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*
keywords: advanced vulvar carcinoma; morbidity; neoadjuvant chemoradiation; surgery; vulvar cancer; vulvectomy