title: Interstitial high-dose-rate brachytherapy in locally advanced and recurrent vulvar cancer.
abstract: OBJECTIVE
  The aim of the study was to report our experience with high-dose-rate interstitial brachytherapy (HDR-ISBT) in locally advanced and recurrent vulvar cancer.
  
  
  METHODS
  Between 2004 and 2014, fourteen women with locally advanced or recurrent vulvar cancer were treated using HDR-ISBT in our Centre. High-dose-rate interstitial brachytherapy was performed as a separate treatment or in combination with external beam radiotherapy (EBRT) (given prior to brachytherapy).
  
  
  RESULTS
  Patients were divided into: group I (n = 6) with locally advanced tumors, stages III-IVA after an incisional biopsy only, and group II (n = 8) with recurrent vulvar cancer after previous radical surgery. In group I, median follow up was 12 months (range 7-18 months); 1-year overall survival (OS) was 83%. Transient arrest of cancer growth or tumor regression was noticed in all patients but 4/6 developed relapse. Median time to failure was 6.3 months (range 3-11 months). The 1-year progression-free survival (PFS) was 33%. In group II, median follow up was 28 months (range 13-90 months). The 1-year and 3-year OS was 100% and 80%, respectively. The arrest of cancer growth or tumor regression was achieved in all patients. In 4/8 patients neither clinical nor histological symptoms of relapse were observed but 4/8 women experienced relapse. Median time to failure was 31 months (range 13-76 months). The 1-year and 3-year PFS was 100% and 62.5%, respectively. Two patients (14.3%) in group II had severe late toxicity (G3).
  
  
  CONCLUSIONS
  High-dose-rate interstitial brachytherapy is a well-tolerated treatment option in selected patients with advanced or recurrent vulvar cancer. It is a safe and effective treatment modality for advanced and recurrent vulvar cancer, yielding good local control with acceptable late treatment related side effects. In our study, patients with recurrent vulvar cancer had better results in HDR-ISBT treatment, probably because of the smaller tumor volume. This hypothesis should be verified in a larger group of patients.
authors.affiliation: Brachytherapy Department, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice Branch.
authors.forename: Sylwia
authors.initials: S
authors.lastname: Kellas-Ślęczka
authors.affiliation: Brachytherapy Department, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice Branch.
authors.forename: Brygida
authors.initials: B
authors.lastname: Białas
authors.affiliation: Brachytherapy Department, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice Branch.
authors.forename: Marek
authors.initials: M
authors.lastname: Fijałkowski
authors.affiliation: Brachytherapy Department, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice Branch.
authors.forename: Piotr
authors.initials: P
authors.lastname: Wojcieszek
authors.affiliation: Department of Radiotherapy and Brachytherapy Planning, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice Branch.
authors.forename: Marta
authors.initials: M
authors.lastname: Szlag
authors.affiliation: Department of Radiotherapy and Brachytherapy Planning, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice Branch.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Cholewka
authors.affiliation: Institute of Mathematics, University of Silesia, Katowice.
authors.forename: Maciej
authors.initials: M
authors.lastname: Ślęczka
authors.affiliation: Department of Epidemiology and Silesia Cancer Registry, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice Branch, Gliwice, Poland.
authors.forename: Zofia
authors.initials: Z
authors.lastname: Kołosza
keywords: HDR; advanced; brachytherapy; interstitial; recurrent; vulvar cancer