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. 2022 Oct 12:44:101086.
doi: 10.1016/j.gore.2022.101086. eCollection 2022 Dec.

Incidence and predictors of toxicity in the management of vulvar squamous cell carcinoma treated with radiation therapy

Neal S McCall  1 , Tony Y Eng  1 , Joseph W Shelton  1 , Sheela Hanasoge  1 , Pretesh R Patel  1 , Ashish B Patel Jr  1 , Ashley A McCook-Veal  2 , Jeffrey M Switchenko  2 , Tonya E Cole  1 , Namita Khanna  3 , Chanhee H Han  3 , Alan N Gordon  3 , Kristen D Starbuck  3 , Jill S Remick  1
Affiliations

Incidence and predictors of toxicity in the management of vulvar squamous cell carcinoma treated with radiation therapy

Neal S McCall et al. Gynecol Oncol Rep. .

Abstract

Purpose/objective: Given the rarity of vulvar cancer, data on the incidence of acute and late severe toxicity and patients' symptom burden from radiotherapy (RT) are lacking.

Materials/methods: This multi-center, single-institution study included patients with vulvar squamous cell carcinoma treated with curative intent RT between 2009 and 2020. Treatment-related acute and late grade ≥ 3 toxicities and late patient subjective symptoms (PSS) were recorded.

Results: Forty-two patients with predominantly stage III/IV disease (n = 25, 59.5 %) were treated with either definitive (n = 25, 59.5 %) or adjuvant (n = 17, 40.5 %) external beam RT to a median dose of 64 Gy and 59.4 Gy, respectively. Five patients received a brachytherapy boost with a median total dose of 84.3 Gy in 2 Gy-equivalent dose (EQD2). Intensity-modulated RT was used in 37 (88.1 %) of patients, and 25 patients (59.5 %) received concurrent chemotherapy. Median follow-up was 27 months. Acute grade ≥ 3 toxicity occurred in 17 patients (40.5 %), including 13 (31.0 %) acute grade 3 skin events. No factors, including total RT dose (p = 0.951), were associated with acute skin toxicity. Eleven (27.5 %) patients developed late grade ≥ 3 toxicity events, including 10 (23.8 %) late grade ≥ 3 skin toxicity events. Patients with late grade ≥ 3 skin toxicity had a higher mean body-mass index (33.0 vs 28.2 kg/m2; p = 0.009). Common late PSS included vaginal pain (n = 15, 35.7 %), skin fibrosis (n = 10, 23.8 %), and requirement of long-term opiates (n = 12, 28.6 %).

Conclusion: RT for vulvar cancer is associated with considerable rates of severe acute and late toxicity and PSS burden. Larger studies are needed to identify risk factors, explore toxicity mitigation strategies, and assess patient-reported outcomes.

Keywords: Intensity-modulated radiation therapy; Radiotherapy; Toxicity; Vulvar cancer.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Local-Regional Control (LRC). A Kaplan-Meier plot for LRC is shown, stratified according to surgical resection.
Fig. 2
Fig. 2
Late Patient Subjective Symptom (PSS) Burden. Subjective symptoms were defined as patient-related complaints documented by providers during follow-up. These data include patients who had developed acute or late grade ≥ 3 toxicities. PSS were not well documented in six (14.3 %) of patients, though the plot is representative of the entire cohort (n = 42).
See this image and copyright information in PMC

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