Chemoradiation as primary or adjuvant treatment for locally advanced carcinoma of the vulva

Purpose: To determine the impact of primary or adjuvant chemotherapy and ra diation (CRT) on the survival rates of patients with locally advanced vulva r carcinoma. Methods and Materials: Between 1973 and 1998, 54 patients with vulvar cance r were treated with radiation therapy, among which 20 received CRT, while 3 4 patients received radiation therapy (RT) alone. Of the 20 patients, 14 we re treated for primary or recurrent disease (pCRT), and 6 after radical vul vectomy for high-risk disease (aCRT). Of the 34 patients, 12 were treated p rimarily (pRT) and 22 received adjuvant treatment (aRT), Chemotherapy consi sted of 2 courses of 5-fluorouracil (5-FU) and mitomycin C administered dur ing RT, Six patients received cisplatin in place of mitomycin C, In CRT gro ups, radiation was administered to the vulva, pelvic, and inguinal lymph no des to a median dose of 45 Gy with additional 6-17 Gy to gross disease. In RT groups, the median dose to the microscopic diseases was 45 Gy, Nine pati ents received external beam boost and 16 patients received supplementary br achytherapy in the forms of Ra-226 or Am-241 plaques to sites of macroscopi c disease. Results: Overall survival was superior in the patients treated with pCRT ve rsus pRT with statistical significance (p = 0.04). There was also a statist ically significant improvement in disease-specific (p = 0.03) and relapse-f ree survival (p = 0.01) favoring pCRT, No statistically significant trends of improved survival rates favoring aCRT over aRT were observed. Conclusion: Concurrent radiation therapy and chemotherapy decreases local r elapse rate, improves disease-specific and overall survival over RT alone a s primary treatment for locally advanced vulvar cancer. (C) 2000 Elsevier S cience Inc.