Radiation alone for carcinoma of the vagina: Variation in response related to the location of the primary tumor

Abstract

A retrospective study of 40 patients with histologically confirmed carcinoma of the vagina is reported. The patients were treated by radiation alone (a combination of external beam therapy and implants) between October 1969 and September 1991 at the Medical College of Virginia Hospital in Richmond. Thirty-three patients (82%) had squamous cell carcinoma, 2 patients (7%) had adenocarcinoma, and 2 patients (5%) had poorly differentiated cancers (1 melanoma and 1 leiomyosarcoma). The patients were staged according to the International Federation of Gynecology and Obstetrics (FIGO) staging system; there were 13 patients (33%) in Stage 1, 21 (52%) in Stage II, 4 (10%) in Stage III, and 2 (5%) in Stage IV. Thirty-six patients (90%) were treated with external beam therapy and some combination of implant: cylinder, ovoid, or interstitial implants with iodine-125 or iridium-192 (afterloading). Only 4 patients (10%) received treatment by implant only. Based on their response, two groups of patients were identified. Group I had 23 patients with tumors predominantly located in the proximal half of the vagina; there were 8 patients in Stage I, 11 in Stage II, 3 in Stage III, and 1 in Stage IV. Of these, three patients failed: one each in Stages III and IV and one Stage II patient was salvaged by surgery. Three patients died due to unrelated causes but with local control. The 5-year actuarial survival in this group was 81%. Group II had 17 patients with tumors located in the mid to distal half of the vagina; there were 5 patients in Stage I, 10 in Stage II, and 2 in Stage IV. Ten patients failed. Eight patients in Stage II had persistent disease, were lost to follow-up, and are presumed dead. Two patients with Stage IV disease also had inadequate local control. The overall actuarial survival in the distal group was 41%, which was significantly worse than the proximal group (81%), at a P value of 0.05. This study discusses the curability of carcinoma of the vagina based on its anatomic location when predominantly similar treatment techniques and radiation doses were applied to either the proximal or the distal part of the vagina, those with cancer in the proximal half had better survival (81%) than those whose cancer was in the distal half (41%).