Abstract
PURPOSE: Treatment of advanced vulvar cancer is challenging. The aim of the study was to investigate the potential of primary (chemo)radiotherapy ((C)RT) with regard to clinical outcome and associated prognostic parameters. METHODS: A total of 39 patients with squamous cell vulvar cancer receiving primary (C)RT were retrospectively identified through hospital databases. Patient and treatment characteristics as well as outcomes were assessed. Survival statistics were calculated using the Kaplan-Meier method. Univariate analysis was performed using the log-rank test and Spearman's correlation to evaluate associations between patient or treatment characteristics and survival outcomes. RESULTS: Median age at diagnosis was 74 years (range 38-92 years). Patients had advanced stage disease with 28.2%/38.5% presenting with FIGO stage III/IV, respectively. All patients received external beam radiotherapy (EBRT) with a median dose to the primary tumor of 66 Gy EQD2 (range 49.6 Gy-72.6 Gy) and to lymph nodes of 53.1 Gy EQD2 (range 44.1 Gy-67.1 Gy). 69.2% received concurrent chemotherapy, mostly cisplatin weekly or mitomycin/5-fluorouracil. 10.3%/64.1% showed clinical complete remission (cCR)/partial remission (cPR) at first follow-up; 7.7% had disease progression. After a median follow-up of 25.5 months (range 0.5-132.9 months), 3‑year locoregional progression-free survival (LRPFS) and overall survival (OS) were 60.2% and 69.6%, respectively. Age and concurrent chemotherapy were the main prognostic parameters associated with improved oncological outcome. CONCLUSION: Definitive (C)RT plays an important role in the management of advanced vulvar cancer with high response rates and satisfactory oncological outcomes. However, there is still room for improvement and future trials are needed to further assess the potential of definitive CRT, especially with regard to possible combinations with immunotherapy.