Outcomes of Definitive Radiation Therapy for Primary Vaginal Carcinoma

The aim of this study was to review treatment and outcomes of patients with primary vaginal cancer treated with definitive radiotherapy.

We retrospectively reviewed medical records of 71 patients with primary vaginal adenocarcinoma or squamous cell carcinoma treated with definitive radiotherapy with at least 2 years of follow-up (median follow-up, 6.24 y).

Ninety-three percent of patients were treated with external-beam radiotherapy plus brachytherapy (median dose, 7540 cGy); 4 patients with stage I disease and 1 patient with stage II disease were treated with brachytherapy alone (median dose, 6000 cGy). The cause-specific 5- and 10-year survival rates, respectively, were 96% and 96% for stage I patients, 75% and 68% for stage II patients, 69% and 64% for stage III patients, and 53% and 53% for stage IVA patients. The 5- and 10-year local-regional control rates for all patients were 79% and 75%, respectively. The 5- and 10-year distant metastasis-free survival rates for all patients were 87% and 85%, respectively. Sixteen patients had tumors involving the distal one third of the vagina. Of the 7 who received elective inguinal node irradiation, 0 failed in the inguinal nodes. Of the 9 who did not receive elective inguinal node irradiation, 2 failed in the inguinal nodes. Severe complications (grades 3 to 4) occurred in 16 patients (23%).

Radiotherapy provides excellent results as definitive treatment for primary vaginal cancer, although the risk of severe complications is high. Generally, treatment should consist of both external-beam radiation therapy and brachytherapy. Inguinal nodes should be irradiated electively when the primary tumor involves the distal one third of the vagina.