Primary carcinoma of the vagina: Tata memorial hospital experience

Purpose: Carcinoma of the vagina is a rare gynecological malignancy compris ing approximately 2% of all the gynecological malignancies. We have analyze d the treatment outcome of the patients treated at the Tata Memorial Hospit al from January 1984 to December 1993, Methods and Materials: In this 10-year period, 134 patients of primary vagi nal cancers were registered at our hospital. Of these, 75 patients received complete treatment and are analyzed. Results: Disease-free survival (DFS) for the whole group is 50%, and overal l survival (OAS) is 60%, Most locoregional recurrences and distant failures are noted in the 2 years following treatment. DFS at 5 years is as follows : Stage I (5 patients), Stage IIA (37 patients), Stage IIB (15 patients), S tage III (14 patients), and Stage IV (4 patients); are 40%, 55%, 60%, 50%, and 25%, respectively. The DFS for patients with complete response (42 pati ents) to external radiation at 5 years is 68%, with partial response (25 pa tients) is 35%, and with poor or no response (6 patients) is 18% (p = 0.000 0), We observed that brachytherapy was an important part of the treatment, and patients who received brachytherapy (59 patients), either with a vagina l intracavitary applicator (30 patients) or interstitial implant (29 patien ts) had a DFS of 53% and 56%, respectively, while 15 patients who received external radiation alone had a DFS of 30%, Patients receiving brachytherapy within 4 weeks of external radiation had a DFS of 60% as compared to 30% w hen the interval was more than 4 weeks. Conclusion: The factors indicating prognosis are: site and extent of involv ement, presence of lymph nodes at presentation, technique of brachytherapy, and interval between external radiation and brachytherapy, (C) 2000 Elsevi er Science Inc.