title: Treatment results and prognostic factors of patients with vulvar cancer treated with postoperative or definitive radiotherapy.
abstract: OBJECTIVE
  Vulvar cancer is a relatively uncommon type of gynecologic cancer. The aim of this study is to analyze the treatment results and prognostic factors of vulvar cancer.
  
  
  METHODS
  Forty-four vulvar cancer patients treated between 2000 and 2011 at the Department of Radiation Oncology, Ege University Faculty of Medicine, were retrospectively reviewed. External radiotherapy (RT) was applied with 6-18 MV linear accelerators with 1.8 Gy daily fractions with a median total dose of 50.4 Gy (45-59.4 Gy) for postoperative cases and 64.8 Gy (range 54-66 Gy) for definitive cases. Statistical analyses were performed with SPSS 13.0.
  
  
  RESULTS
  Among 44 patients with a median age of 68 years (range 28-86), 14 (31.8%) were treated with curative and 30 (68.2%) were treated with postoperative RT or radiochemotherapy (RCT). According to International Federation of Gynecology and Obstetrics staging, 11 (25%) had stage IB, 10 (22.7%) had stage II, 6 (13.6%) had stage IIIA, 5 (11.4%) had stage IIIB, and 12 (27.3%) had stage IVA disease. Within a median of 24 months (range 6-135) of follow-up, 11 (27.3%) patients had local recurrence, 8 had regional recurrence, 2 had both local and regional recurrence, and 6 had distant metastases. Five-year locoregional, disease-free, and overall survival rates were 45%, 40%, and 54%, respectively. Older age, poor tumor differentiation, positive surgical margin, and lymphovascular space invasion were found to be important prognostic factors for disease-related outcomes.
  
  
  CONCLUSIONS
  Prognosis of vulvar cancer remains poor even with a multidisciplinary approach. Molecular prognostic factors need to be defined for individualized treatment options to achieve better treatment results.
authors.affiliation: Department of Radiation Oncology, Ege University Faculty of Medicine, Izmir - Turkey.
authors.forename: Senem
authors.initials: S
authors.lastname: Alanyali
authors.affiliation: Department of Radiation Oncology, Ege University Faculty of Medicine, Izmir - Turkey.
authors.forename: Özge
authors.initials: Ö
authors.lastname: Duran
authors.affiliation: Department of Radiation Oncology, Ege University Faculty of Medicine, Izmir - Turkey.
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Özsaran
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Ege University Faculty of Medicine, Izmir - Turkey.
authors.forename: Aydın
authors.initials: A
authors.lastname: Özsaran
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Ege University Faculty of Medicine, Izmir - Turkey.
authors.forename: Levent
authors.initials: L
authors.lastname: Akman
authors.affiliation: Department of Gynecologic Oncology, Tepecik Training and Research Hospital, Izmir - Turkey.
authors.forename: Ulaş
authors.initials: U
authors.lastname: Solmaz
authors.affiliation: Department of Gynecologic Oncology, Tepecik Training and Research Hospital, Izmir - Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Gökçü
authors.affiliation: Department of Gynecologic Oncology, Tepecik Training and Research Hospital, Izmir - Turkey.
authors.forename: Muzaffer
authors.initials: M
authors.lastname: Sanci
authors.affiliation: Department of Radiation Oncology, Ege University Faculty of Medicine, Izmir - Turkey.
authors.forename: Arif B
authors.initials: AB
authors.lastname: Aras
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy / Q000601:surgery; D018289:Carcinoma, Verrucous / Q000532:radiotherapy / Q000601:surgery; D059248:Chemoradiotherapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007890:Leiomyosarcoma / Q000532:radiotherapy / Q000601:surgery; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D009367:Neoplasm Staging; D009442:Neurilemmoma / Q000532:radiotherapy / Q000601:surgery; D011237:Predictive Value of Tests; D011379:Prognosis; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014846:Vulvar Neoplasms / Q000517:prevention & control / Q000532:radiotherapy* / Q000601:surgery*