Background
Retrospective single-institution series, Brigham and Women's/Dana-Farber (Harvard). N=68, primary vaginal cancer treated with definitive RT, 1974-2011. Outcomes by modality (EBRT ± brachytherapy), histology, and stage; subset received concurrent chemotherapy. Examines four decades of treatment, including transition to IMRT and HDR brachytherapy.
Interventions and follow up
Treatment: Definitive EBRT ± brachytherapy, ± concurrent chemotherapy
Primary endpoint: Local control, disease-free survival, overall survival
mFollow up: Median ~5 yr
Primary endpoint: Local control, disease-free survival, overall survival
mFollow up: Median ~5 yr
Results
5yr local control: ~80% overall; Stage I/II ~86%, Stage III/IVA ~55%
5yr OS: ~56% overall
Chemotherapy association: CRT trended toward improved local control and DFS, especially stage II-IVA (not statistically significant, small N)
5yr OS: ~56% overall
Chemotherapy association: CRT trended toward improved local control and DFS, especially stage II-IVA (not statistically significant, small N)
Adverse events
Grade 3-4 late toxicity: ~12%
Bowel complications: ~7%
Urological: ~5%
Other: no treatment-related deaths; grade 2-3 vaginal stenosis common (not systematically graded)
Bowel complications: ~7%
Urological: ~5%
Other: no treatment-related deaths; grade 2-3 vaginal stenosis common (not systematically graded)
Conclusions
Definitive RT achieves durable local control with acceptable toxicity in primary vaginal cancer, stage being the dominant prognostic factor. The trend toward improved outcomes with concurrent chemotherapy supports its use in locally advanced disease, consistent with larger NCDB analyses. Modern IMRT and HDR brachytherapy may reduce toxicity vs older techniques.
Key Limitations
Small sample (n=68) over four decades with substantial treatment heterogeneity; inadequate power for subgroup or chemotherapy comparisons; open-access (PLoS One) lower-impact venue typical of rare-cancer retrospective series; heterogeneous population; historical bias.
Clinical Context
Adds to limited vaginal cancer RT literature, corroborating the larger MDACC (Frank) series and supporting brachytherapy as essential to definitive treatment. IMRT for EBRT reduces dose to bladder, bowel, and rectum vs 4-field box. Given rarity, all evidence is retrospective; the MDACC and Harvard series are the principal institutional data informing ASCO/ESMO practice.
References