Node-positive carcinoma of the vulva treated with curative-intent radiotherapy

This study aimed to evaluate the outcomes of patients with node-positive vulvar carcinoma treated with radiotherapy, with or without chemotherapy, administered with curative intent, focusing on patterns of first failure, locoregional control, and overall survival.

Patients were eligible if they had a histologic diagnosis of node-positive vulvar cancer and were referred for curative-intent radiotherapy, with or without chemotherapy, either as the primary treatment or in the adjuvant setting following definitive surgery between January 2000 and December 2019 at our institution. Eligible patients were selected from the prospective database of the gynecology oncology unit, where clinical, histopathologic, treatment, and follow-up data were systematically collected for analysis.

Out of 256 patients with vulvar cancer, 88 (34.4%) patients met the inclusion criteria. The median age was 65 years (range; 33-90). Sixty-two patients underwent surgery and adjuvant radiotherapy, of whom 57 (92%) received concomitant chemotherapy. Twenty-four patients received definitive chemoradiotherapy and 2 received definitive radiotherapy alone. The median total dose to the primary site was 54 Gy in the definitive setting and 45 Gy in the adjuvant setting. The median dose was 54 Gy (range; 45-60) to gross inguinal nodes (n = 48) and 54 Gy (range; 34-64) to gross primary disease (n = 26). The median follow-up was 5.3 years (range; 0.1-21.8). Five-year overall survival was 62% in the adjuvant group and 50% in the definitive group. Of 88 patients, 46 (52%) relapsed; 16 of 46 (35%) had failure at the primary site alone. Disease control at the primary site and nodes was 64% (95% CI; 48%-75%) in the adjuvant group and 49% (26%-68%) in the definitive group at 5 years.

Locoregional control and overall survival were highest in patients treated with surgery followed by radiotherapy. Definitive chemoradiotherapy provided moderate disease control and survival outcomes in patients unfit for surgery, supporting its use as an alternative treatment strategy.