Abstract
Background
Primary vaginal carcinoma is rare, accounting for 1–2 % of all gynecological malignancies. Being rare, most observations are based on retrospective and comparative analyses. This study was aimed to retrospectively analyze the prognostic factors and its relevance in the outcomes of primary vaginal cancers.
Materials
Medical records of all cases of primary vaginal cancers, presented to Department of Oncology, from 2004 to 2012, at a tertiary care center in southern India, were retrieved from electronic medical records, and were analyzed.
Results
The total number of cases was 32. Median age at presentation was 64.28 years. Squamous histology accounted for 84.4 %, with the rest being adenocarcinoma. Surgery was offered for five (15.6 %), and concurrent chemotherapy for 14 (43.8 %) patients. Three patients had only surgery. All others received radiotherapy. Twenty received external beam radiation (EBRT) and vaginal brachytherapy (VBT); seven only EBRT and two, adjuvant radiation. Five patients had residual disease; two, stage III, and three stage IV. Median follow-up was 55.83 months. Twelve patients were alive at last follow-up (37.5 %), while 14 were dead (43.8 %—8 of disease and 6 of other causes). Six patients were lost to follow-up (18.8 %). Twenty patients were disease free. Seven had recurrence, three loco-regional and four distant. Median overall survival (OS) was 86.1 months, disease-free survival (DFS) 90.17 months, and disease-specific survival (DSS) 97.13 months. When well and moderately differentiated tumors were taken together, the 5-year OS, DFS, and DSS rates were, 56.6, 64.3, and 82.3 %. For poorly differentiated tumors, median OS, DFS, and DSS were, 20.9, 14.6, and 20.9 months, with statistically significant advantage for better grade tumors, for DSS (p 0.050). Better 5-year OS, DFS, and DSS rates were observed for stage I + II group, with 54.9, 79.8, and 78.9 %, compared with advanced stage where the same were 54.8, 38.2, and 68.6 % (DFS—p 0.003, DSS—p 0.009). Grade and stage of tumor had statistically significant predictive value over the outcomes, while tumor size showed a significant trend. Patients treated with combination of EBRT and VBT fared well.
Conclusion
Our study could conclude that grade of differentiation was a significant predictor of poor survival as was stage of disease. Combination of VBT and external beam radiotherapy provides good DFS.
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References
Di Donato V, Bellati F, Fischeti M, et al. Vaginal cancer. J Crit Rev Oncol/Hematol. 2012;81:286–95.
Taussig FJ. Primary cancer of the vulva, vagina and female urethra: 5 year results. Surg Gynecol Obstet. 1935;60:477–88.
Stryker JA. Radiotherapy for vaginal carcinoma: a 23-year review. Br J Radiol. 2000;73:1200–5.
Kosary CL. Cancer of the vagina. In: Ries LA, Young JL, Keel GE, et al (eds.). SEER survival monographs: cancer survival among adults: U.S.Seer Program, 1988 [NIH Pub.No07-6215]. Bethesda (MD): National Cancer Institute; 2007. p. 155–160.
Lian J, Dundas G, Carlone M, et al. Twenty year review of radiotherapy for vaginal cancer: an institutional experience. Gynecol Oncol. 2008;111:298–306.
Chyle V, Zagras GK, Wheeler JA, et al. Definitive radiotherapy for carcinoma of the vagina: outcomes and prognostic factors. Int J Radiat Oncol Biol Phys. 1996;35(5):891–905.
Frank SJ, Jhingran A, Levenback C, et al. Definitive radiation therapy for squamous cell carcinoma of the vagina. Int J Radiat Oncol Biol Phys. 2005;62(1):138–47.
Platta CS, Anderson B, Geye H, et al. Adjuvant and definitive radiation therapy for primary carcinoma of the vagina using brachytherapy and external beam radiation therapy. J Contemp Brachytherapy. 2013;5(2):76–82.
Miyamoto DT, Viswanathan AN. Concurrent chemoradiation for vaginal cancer. PLoS One. 2013;8(6):e65048.
Creasman WT, Phillips JL, Meneck HR. The national cancer data base report on cancer of the vagina. Cancer. 1998;83(5):1033–40.
Hellman K, Lundell M, Silfversward C, et al. Clinical and histopathologic factors related to prognosis in primary squamous cell carcinoma of the vagina. Int J Gynecol Cancer. 2006;16(3):1201–11.
Hiniker SM, Roux A, Murphy JD, et al. Primary squamous cell carcinoma of the vagina: prognostic factors, treatment patterns, and outcomes. Gynecol Oncol. 2013;131:380–5.
Fleming P, Syed AMN, Neblett D, et al. Description of an after-loading Ir-192 interstitial-intra-cavitary technique in the treatment of carcinoma of the vagina. Obstet Gynecol. 1980;55:525–30.
Kirkbride P, Fyles A, Rawlings GA, et al. Carcinoma of the vagina—experience at the Princess Margaret Hospital (1974–1989). Gynecol Oncol. 1995;56:435–43.
Kucera H, Vavra N. Radiation management of primary carcinoma of the vagina: clinical and histopathological variables associated with survival. Gynecol Oncol. 1991;40:12–6.
Ali MM, Huang DT, Howels R, et al. Radiation alone for carcinoma of vagina: variation in response related to the location of the primary tumor. Cancer. 1996;77:1934–9.
Perez CA, Grigsby PW, Garipagaoglu M, et al. Factors affecting long-term outcome of irradiation in carcinoma of the vagina. Int J Radiat Oncol Biol Phys. 1999;44:37–45.
Jang WI, Wu HG, Ha SW, et al. Definitive radiotherapy for treatment of primary vaginal cancer: effectiveness and prognostic factors. Int J Gynecol Cancer. 2012;22(3):521–7.
Kucera H, Mock U, Knocke TH, et al. Radiotherapy alone for invasive vaginal cancer: outcome with intra-cavitary high dose rate brachytherapy versus conventional low dose rate brachytherapy. Acta Obstet Gynecol Scand. 2001;80(4):355–60.
Murakami N, Kasamatsu T, Sumi M, et al. Radiation therapy for primary vaginal carcinoma. J Radiat Res. 2013;54(5):931–7.
Miyamoto DT, Tanaka CK, Viswanathan AN. Concurrent chemoradiation improves survival in patients with vaginal cancer. Int J Radiat Oncol Biol Phys. 2010;10(3):s120 (abstract).
Miyamoto DT, Viswanathan AN. Concurrent chemoradiation for vaginal cancer. PLoS One. 2013;8(6):e65048.
Ghia AJ, Gonzalez VJ, Tward JD, et al. Primary vaginal cancer and chemoradiotherapy: a pattern-of-care analysis. Int J Gynecol Cancer. 2011;21(2):378–84.
Blecharz P, Reinfuss M, Jakubowicz J, et al. Radiation therapy complications in patients with primary invasive vaginal carcinoma. Ginekol Pol. 2013;84(3):206–10.
Compliance with Ethical Requirements and Conflict of Interest
This is a retrospective analysis of all cases of primary vaginal cancers presented to our tertiary care institute from 2004 to 2012. Hence no ethical issues were involved. No conflict of interest.
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Dr. Chelakkot G. Prameela is an Associate Professor at Amrita Institute of Medical Sciences; Dr. Rahul Ravind is a Resident at Amrita Institute of Medical Sciences; Dr. Bharath C. Gurram is a Resident at Amrita Institute of Medical Sciences; Ms. V. S. Sheejamol is a Lecturer at Amrita Institute of Medical Sciences; and Dr. Makuny Dinesh is a Professor at Amrita Institute of Medical Sciences.
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Prameela, C.G., Ravind, R., Gurram, B.C. et al. Prognostic Factors in Primary Vaginal Cancer: A Single Institute Experience and Review of Literature. J Obstet Gynecol India 66, 363–371 (2016). https://doi.org/10.1007/s13224-015-0697-6
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DOI: https://doi.org/10.1007/s13224-015-0697-6