title: Definitive treatment of primary vaginal cancer with radiotherapy: multi-institutional retrospective study of the Korean Radiation Oncology Group (KROG 12-09).
abstract: OBJECTIVE
  To assess the outcome of the treatment of primary vaginal cancer using definitive radiotherapy (RT) and to evaluate the prognostic factors of survival.
  
  
  METHODS
  The medical records of nine institutions were retrospectively reviewed to find the patients with vaginal cancer treated with definitive RT with or without chemotherapy. A total of 138 patients met the inclusion criteria. None had undergone curative excision.
  
  
  RESULTS
  The median follow-up time of the survivors was 77.6 months and the median survival time was 46.9 months. The 5-year overall survival, cancer-specific survival (CSS), and progression-free survival (PFS) rates were 68%, 80%, and 68.7%, respectively. In the survival analysis, the multivariate analysis showed that a lower the International Federation of Gynecology and Obstetrics (FIGO) stage and prior hysterectomy were favorable prognostic factors of CSS, and a lower FIGO stage and diagnosed prior to year 2000 were favorable prognostic factors of PFS. In the subgroup analysis of the patients with available human papillomavirus (HPV) results (n=27), no statistically significant relationship between the HPV status and recurrence or survival was found. Grade 3 or 4 acute and late toxicity were present in 16 and 9 patients, respectively. The FIGO stage and the tumor size were predictors of severe late toxicity.
  
  
  CONCLUSIONS
  The data clearly showed that a higher FIGO stage was correlated with a worse survival outcome and higher severe late toxicity. Therefore, precise RT and careful observation are crucial in advanced vaginal cancer. In this study, the HPV status was not related to the survival outcome, but its further investigation is needed.
authors.affiliation: Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Ji Hyun
authors.identifier: http://orcid.org/0000-0001-5921-5522
authors.initials: JH
authors.lastname: Chang
authors.affiliation: Department of Radiation Oncology, Korea Institute of Radiological & Medical Science, Seoul, Korea.
authors.forename: Won Il
authors.identifier: http://orcid.org/0000-0002-5279-3087
authors.initials: WI
authors.lastname: Jang
authors.affiliation: Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Yong Bae
authors.identifier: http://orcid.org/0000-0003-4884-2330
authors.initials: YB
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
authors.forename: Jin Hee
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Young Seok
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Yeon Sil
authors.identifier: http://orcid.org/0000-0003-1291-0821
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Won
authors.initials: W
authors.lastname: Park
authors.affiliation: Department of Radiation Oncology, Cheil General Hospital & Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea.
authors.forename: Juree
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.
authors.forename: Won Sup
authors.identifier: http://orcid.org/0000-0002-6098-1993
authors.initials: WS
authors.lastname: Yoon
authors.affiliation: Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
authors.forename: Joo-Young
authors.initials: JY
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea. khjae@snu.ac.kr.
authors.forename: Hak Jae
authors.identifier: http://orcid.org/0000-0003-3602-2263
authors.initials: HJ
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary / Q000821:virology; D059248:Chemoradiotherapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D009367:Neoplasm Staging; D030361:Papillomavirus Infections / Q000175:diagnosis; D011878:Radiotherapy / Q000009:adverse effects; D056910:Republic of Korea; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D047368:Tumor Burden; D014625:Vaginal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000821:virology
keywords: Radiotherapy; Stage; Vaginal Neoplasms