title: Definitive radiotherapy for primary vaginal cancer: correlation between treatment patterns and recurrence rate.
abstract: The purpose of this study was to determine the outcomes and optimal practice patterns of definitive radiotherapy for primary vaginal cancer. Between 1993 and 2012, 49 patients were treated with definitive radiotherapy for primary vaginal cancer in three hospitals. Of these, 15 patients (31%) had clinically positive regional lymph node metastasis. A total of 34 patients (70%) received external beam radiotherapy with high-dose-rate brachytherapy (interstitial or intracavitary), and 8 (16%) (with small superficial Stage I tumors) were treated with local radiotherapy. The median follow-up was 33 months (range: 1-169 months). The 3-year overall survival (OS), disease-free survival (DFS), and loco-regional control (LRC) rates were 83%, 59% and 71%, respectively. In multivariate analysis, the histological type (P = 0.044) was significant risk factors for LRC. In Federation of Gynecology and Obstetrics (FIGO) Stage I cases, 3 of 8 patients (38%) who did not undergo prophylactic lymph node irradiation had lymph node recurrence, compared with 2 of 12 patients (17%) who underwent prophylactic pelvic irradiation. For Stage III-IV tumors, the local recurrence rate was 50% and the lymph node recurrence rate was 40%. Patients with FIGO Stage I/II or clinical Stage N1 had a higher recurrence rate with treatment using a single modality compared with the recurrence rate using combined modalities. In conclusion, our treatment outcomes for vaginal cancer were acceptable, but external beam radiotherapy with brachytherapy (interstitial or intracavitary) was needed regardless of FIGO stage. Improvement of treatment outcomes in cases of FIGO Stage III or IV remains a significant challenge.
authors.affiliation: Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamadaoka, Suita, Osaka 565-0871, Japan Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari, Osaka 537-8511, Japan.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Kanayama
authors.affiliation: Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamadaoka, Suita, Osaka 565-0871, Japan isohashi@radonc.med.osaka-u.ac.jp.
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Isohashi
authors.affiliation: Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamadaoka, Suita, Osaka 565-0871, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Yoshioka
authors.affiliation: Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamadaoka, Suita, Osaka 565-0871, Japan.
authors.forename: Sungjae
authors.initials: S
authors.lastname: Baek
authors.affiliation: Department of Radiation Oncology, Osaka Rosai Hospital, 1179-3 Nagasone-cyo, kita-ku, Sakai, Osaka 591-8025, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Chatani
authors.affiliation: Department of Radiation Oncology, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka 540-0006, Japan.
authors.forename: Tadayuki
authors.initials: T
authors.lastname: Kotsuma
authors.affiliation: Department of Radiation Oncology, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka 540-0006, Japan.
authors.forename: Eiichi
authors.initials: E
authors.lastname: Tanaka
authors.affiliation: Department of Radiology, Osaka Medical College.
authors.forename: Ken
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamadaoka, Suita, Osaka 565-0871, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Seo
authors.affiliation: Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamadaoka, Suita, Osaka 565-0871, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Suzuki
authors.affiliation: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine.
authors.forename: Seiji
authors.initials: S
authors.lastname: Mabuchi
authors.affiliation: Department of Obstetrics and Gynecology, Osaka Rosai Hospital.
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Shiki
authors.affiliation: Department of Obstetrics and Gynecology, National Hospital Organization Osaka National Hospital.
authors.forename: Keiji
authors.initials: K
authors.lastname: Tatsumi
authors.affiliation: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kimura
authors.affiliation: Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari, Osaka 537-8511, Japan.
authors.forename: Teruki
authors.initials: T
authors.lastname: Teshima
authors.affiliation: Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamadaoka, Suita, Osaka 565-0871, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Ogawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D007564:Japan; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000517:prevention & control*; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000379:methods*; D013223:Statistics as Topic; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D014625:Vaginal Neoplasms / Q000473:pathology / Q000532:radiotherapy*
keywords: high-dose-rate brachytherapy; prophylactic pelvic irradiation; radiotherapy; vaginal cancer