Primary invasive carcinoma of the vagina - Treatment with interstitial brachytherapy

BACKGROUND. Because primary carcinoma of the vagina comprises less than 2% of all gynecologic malignancies, the reported experience in the treatment o f large numbers of patients is available only from a few major centers and most often encompasses a variety of differences in treatment selection and technique. The objective of this study was to assess the long term results of an interstitial iridium-192 afterloading implant technique using the Sye d-Neblett dedicated vaginal plastic template. METHODS. Patients who were treated from 1976 to 1997 were examined retrospe ctively. RESULTS. Seventy-one patients underwent interstitial implantation with (n = 61 patients) or without external beam radiotherapy. The median age was 59 years (range, 16-86 years). Patients were staged according to the internati onal Federation of Gynecology and Obstetrics system and included Stage I (n = 10 patients), Perez modification Stage IIA (n = 14 patients), Perez modi fication Stage IIB (n = 25 patients), Stage III (n = 15 patients), and Stag e nr (n = 7 patients). Each implant delivered an approximately 20-gray (Gy) minimum tumor dose, with the total tumor dose reaching 80 Gy with integrat ed external beam radiotherapy. Local control was achieved in 53 patients (7 5%). The median follow-up was 66 months (range, 15-163 months), and the 2-y ear, 5-year, and 10-year actuarial disease free survival rates are 73%, 58% , and 58%, respectively. By stage, 5-year disease free survival rates inclu ded Stage I, 100% of patients; Stage IIA, 60% of patients; Stage IIB, 61% o f patients; Stage III, 30% of patients; and Stage IV, 0% of patients. The f actors disease stage and primary lesion size independently influenced the s urvival rates. Significant complications occurred in 9 patients (13%) and i ncluded necrosis (n = 4 patients), fistulae (n = 4 patients), and small bow el obstruction (n = I patient). CONCLUSIONS. Interstitial irradiation can effect local control in the major ity of patients with primary carcinoma of the vagina with acceptable morbid ity. Long term cure is demonstrable in patients with Stage I-III disease. ( C) 2001 American Cancer Society.