RADIOTHERAPY ALONE FOR CARCINOMA OF THE VAGINA - THE IMPORTANCE OF OVERALL TREATMENT TIME

Purpose: Review treatment results, complications, and the importance o f overall treatment time for carcinoma of the vagina treated with radi otherapy alone. Methods and Materials: Between October 1964 and Octobe r 1990, 65 patients with histologically confirmed carcinoma of the vag ina received definitive radiotherapy at the University of Florida. All patients had a minimum 2-year follow-up. Most patients were treated; with a combination of external-beam radiotherapy and brachytherapy. Th e probability of pelvic control, cause-specific survival, and complica tions was calculated and multivariate analyses were performed. The log -rank test was used to determine significance levels between the curve s.Results: The 5-year cause-specific survival rates were, Stage 0 (six patients), 100%; Stage I (17 patients), 94%; Stage IIA (six patients) , 80%; Stage IIB (ten patients), 39%; Stage III (twn patients), 79%; a nd Stage IVA (six patients), 62%. The pelvic control rates at 5 years were: Stage 0, 100%; Stage I, 87%; Stage IIA, 88%; Stage IIB, 68%; Sta ge III, 80%; and Stage IVA, 67%. The parameters of stage, patient age, total dose to primary site, and overall treatment time were evaluated in a multivariate analysis. The single most important predictor of pe lvic control was overall treatment time. If the entire course of radio therapy (external beam + implant) was completed within 9 weeks (63 day s), the pelvic control rate was 97%. The pelvic control rate was only 54% if treatment time extended beyond 9 weeks (p = .0003). The rate of severe complications was 12%, and the incidence increased with increa sing total primary dose. Conclusion: Radiotherapy alone can cure a sig nificant proportion of patients with carcinoma of the vagina. Treatmen t should be completed without significant interruption, preferably wit hin 9 weeks.