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The British Journal of Radiology, Vol 73, Issue 875 1200-1205, Copyright © 2000 by British Institute of Radiology

ARTICLES

Radiotherapy for vaginal carcinoma: a 23-year review

JA Stryker
Department of Radiology/Radiation Oncology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA.

The purpose of the study was to evaluate prognostic variables and morbidity in patients with vaginal carcinoma. 34 patients, mean age 67 years (+/- 8 SD), were treated between 1976 and 1994. 14 patients had a history of prior hysterectomy. In 13 of the 34 patients the tumour site was the upper vagina, in 9 it was the middle third, in 8 the lower third and in 4 the entire length of the vagina. Disease stage was I in 9 patients, II in 16, III in 7 and IV in 2. There were four treatment groups: external beam therapy + intracavitary brachytherapy (Group WPIC, n = 15); external beam therapy + interstitial brachytherapy (Group WPIS, n = 10); external beam therapy alone (Group WP, n = 7); and brachytherapy alone (Group BA, n = 2). Kaplan-Meier estimates and log-rank tests were used to evaluate survival. Disease-specific 5-year survival was 68% for 28 patients with squamous cell carcinoma and 50% for 6 patients with adenocarcinoma (p-value 0.3). 5-year survival was 78% for stage I disease, 63% for stage II, 33% for stage III and 50% for stage IV (p-value 0.2). Vaginal site of carcinoma, history of hysterectomy and treatment type are not significant prognostic factors. Local failure occurred in 2 patients (13%) in the WPIC group, 2 (20%) in WPIS, 3 (43%) in WP and 1 (50%) in BA. 9 patients (26%) had late small/large intestine and/or bladder morbidity. Vaginal morbidity occurred in 15 patients (44%); 9/15 (60%) in the WPIC group and 3/10 (30%) in the WPIS group having vaginal morbidity. This means that, when combining external beam therapy with brachytherapy, interstitial techniques are preferred over intracavitary techniques.




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