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

• Type of Material: Article
• Authors: Neal S McCall, Emory University; Tony Eng, Emory University; Joseph Shelton, Emory University; Sheela Hanasoge, Emory University; Pretesh Patel, Emory University; Ashish B Patel Jr, Emory University; Ashley A McCook-Veal, Emory University; Jeffrey Switchenko, Emory University; Tonya E Cole, Emory University; Namita Khanna, Emory University; Chanhee Han, Emory University; Alan Gordon, Emory University; Kristen Starbuck, Emory University; Jill Remick, Emory University
• Language: English
• Date: 2022-12-01
• Publisher: Emory University Libraries
• Publication Version: Final Published Version
• Copyright Statement: © 2022 The Authors
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.gore.2022.101086
• Title of Journal or Parent Work: Gynecologic Oncology Reports
• Volume: 44
• Start Page: 101086
• End Page: 101086
• Grant/Funding Information: This work was supported through the Winship Cancer Institute Cancer Center Support Grant, 5P30CA138292l.
• Keywords: Vulvar cancer; Intensity-modulated radiation therapy; Toxicity; Radiotherapy
• Research Categories: Health Sciences, Obstetrics and Gynecology; Health Sciences, Oncology

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.