RADIATION ALONE FOR CARCINOMA OF THE VAGINA - VARIATION IN RESPONSE RELATED TO THE LOCATION OF THE PRIMARY TUMOR

BACKGROUND, A retrospective study of 40 patients with histologically c onfirmed carcinoma of the vagina is reported. The patients were treate d by radiation alone (a combination of external beam therapy and impla nts) between October 1969 and September 1991 at the Medical College of Virginia Hospital in Richmond. METHODS, Thirty-three patients (82%) h ad squamous cell carcinoma, 2 patients (7%) had adenocarcinoma, and 2 patients (5%) had poorly differentiated cancers (1 melanoma and 1 leio myosarcoma). The patients were staged according to the International F ederation of Gynecology and Obstetrics (FIGO) staging system; there we re 13 patients (33%) in Stage I, 21 (52%) in Stage II, 4 (10%) in Stag e III, and 2 (5%) in Stage IV. Thirty-six patients (90%) were treated with external beam therapy and some combination of implant: cylinder, ovoid, or interstitial implants with iodine-125 or iridium-192 (afterl oading). Only 4 patients (10%) received treatment by implant only. RES ULTS, Based on their response, two groups of patients were identified. Group I had 23 patients with tumors predominantly located in the prox imal half of the vagina; there were 8 patients in Stage I, 11 in Stage II, 3 in Stage III, and 1 in Stage IV. Of these, three patients faile d: one each in Stages III and TV and one Stage II patient was salvaged by surgery. Three patients died due to unrelated causes but with loca l control. The 5-year actuarial survival in this group was 81%. Group II had 17 patients with tumors located in the mid to distal half of th e vagina; there were 5 patients in Stage I, 10 in Stage II, and 2 in S tage IV. Ten patients failed. Eight patients in Stage II had persisten t disease, were lost to follow-up, and are presumed dead. Two patients with Stage IV disease also had inadequate local control. The overall actuarial survival in the distal group was 41%, which was significantl y worse than the proximal group (81%), at a P value of 0.05. CONCLUSIO NS. This study discusses the curability of carcinoma of the vagina bas ed on its anatomic location when predominantly similar treatment techn iques and radiation doses were applied to either the proximal or the d istal part of the vagina, those with cancer in the proximal half had b etter survival (81%) than those whose cancer was in the distal half (4 1%).