EFFECTIVENESS OF BRACHYTHERAPY IN TREATING CARCINOMA OF THE VULVA

Purpose: Radical radiotherapeutic management of vulvar cancer often in corporates brachytherapy as a cancer portion of the treatment regimen. However, few studies using this modality alone to manage vulvar cance r have been published. Methods and Materials: Thirty four patients wer e treated with iridium-192 (Ir-192) brachytherapy for vulvar cancer be tween 1975 and 1993 at Centre Alexis Vautrin, Twenty-one patients were treated at first presentation when surgery was contraindicated or dec lined. Of these patients, 12 had International Federation of Gynecolog y and Obstetrics Classification Stage III or TV disease, 8 were Stage II, 1 was Stage I, and 1 was Stage O. Thirteen patients were treated f or recurrent disease. Paris system rules for implantation and dose pre scription were followed. The median reference dose was 60 Gy (range 53 to 88 Gy). At the time of analysis, 10 of 34 patients were alive. Med ian follow-up in these 10 patients was 31 months (range: 21 months to 107 months). Fourteen of the 24 deaths were from causes other than vul var cancer. Results: Kaplan-Meier actuarial 5-year local control was 4 7% (95% confidence interval (CI) = 23 to 73%) and 5-year actuarial loc o-regional control was 45% (95% CI = 21 to 70%). Kaplan-Meier actuaria l 5-year disease-specific survival was 56% (95% CI = 33 to 76%) and ac tuarial 5-year survival was 29% (95% CI = 15 to 49%). Median time to d eath was 14 months. Subset analysis revealed a higher actuarial 5-year local control in patients treated at first presentation than those tr eated for recurrence (80 vs. 19%, log rank, p = 0.04. Similarly, actua rial 5-year loco-regional control was higher in patients treated at fi rst presentation (80 vs. 16%, log rank, p = 0.01). The two groups did not differ significantly in disease-specific or overall survival. The actuarial 5-year disease specific survival of 56% is somewhat Less tha n the expected 5-year disease-specific survival after surgery in a gro up having a similar proportion of early stage, advanced stage, and rec urrent vulvar cancer. Conclusions: Brachytherapy is an effective treat ment for patients with carcinoma of the vulva who decline surgery or i n whom surgery is contraindicated.