ADJUVANT RADIATION FOR VULVAR CARCINOMA - IMPROVED LOCAL-CONTROL

Purpose: Local recurrence is a significant problem following primary s urgery for advanced vulva carcinoma, The objectives of this study were to evaluate the impact of adjuvant vulvar radiation on local control in high risk patients and the impact of local recurrence on overall su rvival, Methods and Materials: From 1980-1994, 62 patients with invasi ve vulva carcinoma and either positive or close (less 8 mm) margins of excision were retrospectively studied, Thirty-one patients were treat ed with adjuvant radiation therapy to the vulva and 31 patients were o bserved after surgery. Kaplan-Meier estimates and the Cox proportional hazard regression model were used to evaluate the effect of adjuvant radiation therapy on local recurrence and overall survival, Independen t prognostic factors for local recurrence and survival were also asses sed. Results: Local recurrence occurred in 58% of observed patients an d 16% in patients treated with adjuvant radiation therapy, Adjuvant ra diation therapy significantly reduced local recurrence rates in both t he close margin and positive margin groups (p = 0.036, p = 0.0048). On both univariate and multivariate analysis adjuvant radiation and marg ins of excision were significant prognostic predictors for local contr ol, Significant determinants of actuarial survival included Internatio nal Federation of Gynecologists and Obstetricians (FIGO) stage, percen tage of pathologically positive inguinal nodes and margins of excision , The positive margin observed group had a significantly poorer actuar ial 5 year survival than the other groups (p = 0.0016) and adjuvant ra diation significantly improved survival for this group. The 2 year act uarial survival after developing local recurrence was 25%, Local recur rence was a significant predictor for death from vulva carcinoma (risk ratio 3.54). Conclusion: Local recurrence is a common occurrence in h igh risk patients, In this study adjuvant radiation therapy significan tly reduced local recurrence rates and may improve overall survival in certain subgroups. As salvage rates after developing local recurrence are poor adjuvant vulvar radiation should be considered for patients at risk after primary surgery. (C) 1997 Elsevier Science Inc.