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Long-Term Results of Radiotherapy in Primary Carcinoma of the Vagina

Langzeitergebnisse der Strahlentherapie beim primären Vaginalkarzinom

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Background:

The long-term results of radiotherapy in primary carcinoma of the vagina are not well defined.

Patients and Methods:

The treatment results of 41 patients with primary malignancies of the vagina were analyzed. The mean follow-up period was 77.3 months (2.3–404 months). The predominant histology was squamous cell carcinoma, FIGO stages I: n = 7 (17.1%), II: n = 13 (31.7%), III: n = 13 (31.7%), and IVa: n = 8 (19.5%). Radiotherapy was the primary treatment for all patients. None of the patients had undergone prior surgery for vaginal carcinoma. The majority of patients received pelvic irradiation, including treatment of the inguinal lymphatics (median dose: 50 Gy). 26 patients received additional intravaginal brachytherapy.

Results:

Overall, 21 patients (51.2%) achieved complete remission, 17 patients (41.5%) had partial responses, and three patients (7.3%) had no change or progressive disease. The total median survival of the analyzed patients was 41.3 months. The 1-year survival probability was 85.4%, the 5-year survival probability 40.6%, and the 10-year survival probability 27.2%. Univariate analysis revealed a survival advantage for earlier tumor stages (FIGO I and II) compared to advanced stages (FIGO III and IV), with a median survival of 58.1 months compared to 26.8 months. Treatment side effects were tolerable and easily managed.

Conclusion:

Definite radiotherapy is the treatment of choice for primary carcinomas of the vagina. Considering that primary malignancies of the vagina are typically diseases of the elderly, it should be noted that radiotherapy is especially well tolerated in this population.

Hintergrund:

Die Langzeitergebnisse der Strahlentherapie beim primaren Vaginalkarzinom sind nicht gut definiert.

Patienten und Methodik:

Die Behandlungsergebnisse von 41 Patientinnen mit primaren Vaginalkarzinomen wurden analysiert. Der mittlere Nachbeobachtungszeitraum betrug 77,3 Monate (2,3–404 Monate). Histologisch lagen uberwiegend Plattenepithelkarzinome vor, FIGO-Stadien I: n = 7 (17,1%), II: n = 13 (31,7%), III: n = 13 (31,7%), IVa: n = 8 (19,5%). Bei allen Patientinnen war die Strahlentherapie die primare Behandlungsform, keine Patientin hatte sich vor Bestrahlungsbeginn einer chirurgischen Intervention unterzogen. Der Grosteil der Patientinnen erhielt eine Beckenbestrahlung, welche die inguinalen Lymphbahnen einschloss (mittlere Dosis: 50 Gy). 26 Patientinnen erhielten zusatzlich eine intravaginale Brachytherapie.

Ergebnisse:

Insgesamt erreichten 21 Patientinnen (51,2%) eine komplette Remission, 17 Patientinnen (41,5%) wiesen eine partielle Remission auf, und drei Patientinnen (7,3%) zeigten keine Veranderung bzw. ein Fortschreiten der Erkrankung. Das Gesamtuberleben fur alle Patientinnen lag im Median bei 41,3 Monaten. Die 1-Jahres-Uberlebenswahrscheinlichkeit betrug 85,4%, die 5-Jahres-Uberlebenswahrscheinlichkeit 40,6% und die 10-Jahres-Uberlebenswahrscheinlichkeit 27,2%. Die univariate Analyse zeigte einen Uberlebensvorteil fur die fruhen Tumorstadien (FIGO I und II) im Vergleich zu den fortgeschrittenen Stadien (FIGO III und IV) bei einem medianen Uberleben von 58,1 Monaten im Vergleich zu 26,8 Monaten. Die unerwunschten Nebenwirkungen waren tolerabel und leicht zu beherrschen.

Schlussfolgerung:

Die definitive Strahlentherapie ist die Therapie der Wahl bei primarem Vaginalkarzinom. In Anbetracht der Tatsache, dass primare Neoplasien der Vagina typischerweise eine Erkrankung des alteren Menschen sind, muss betont werden, dass gerade die Strahlentherapie in dieser Population gut toleriert wird.

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Correspondence to Oliver Micke.

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Hegemann, S., Schäfer, U., Lellé, R. et al. Long-Term Results of Radiotherapy in Primary Carcinoma of the Vagina. Strahlenther Onkol 185, 184–189 (2009). https://doi.org/10.1007/s00066-009-1930-y

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