Background
SEER database analysis of primary vaginal cancer. Population-based cohort reported 1998-2012 (n=~2,100). Trends in treatment utilization (surgery vs radiation) and association with overall survival; population-level complement to institutional series. Factors associated with receipt of RT and survival across stages.
Interventions and follow up
Treatment groups: RT (definitive or adjuvant) vs surgery vs combination vs no treatment, analyzed by stage, histology, and year of diagnosis
Primary endpoint: Overall survival; treatment utilization trend
mFollow up: Median ~3 yr (SEER)
Primary endpoint: Overall survival; treatment utilization trend
mFollow up: Median ~3 yr (SEER)
Results
5yr OS, stage I: ~84% with definitive RT vs ~86% with surgery (not significantly different)
5yr OS, stage II: ~55% with RT-based treatment
Chemotherapy use: increasing over time; associated with improved OS on multivariate analysis for stages II-IVA
Overall trend: increasing use of combined-modality treatment (CRT) over the study period
5yr OS, stage II: ~55% with RT-based treatment
Chemotherapy use: increasing over time; associated with improved OS on multivariate analysis for stages II-IVA
Overall trend: increasing use of combined-modality treatment (CRT) over the study period
Adverse events
Main adverse events: Administrative database; no toxicity data available
Toxicity data: Not captured in SEER
Toxicity data: Not captured in SEER
Conclusions
Population-level data confirm RT is the predominant modality for primary vaginal cancer, with concurrent chemotherapy use increasing over time and associated with improved survival in locally advanced stages. Surgery and RT produce comparable outcomes for stage I. Rising CRT adoption mirrors guideline changes driven by institutional series and NCDB data.
Key Limitations
SEER lacks chemotherapy details (agents, doses, cycles), brachytherapy details (technique, dose), and RT modality (IMRT vs conventional); no disease-specific survival endpoint (OS only); relatively short follow-up; selection bias between surgery vs RT patients; no quality-of-life data.
Clinical Context
Complements the Creasman NCDB (1998) and Rajagopalan NCDB (2014) analyses, demonstrating population-level trends toward CRT adoption in vaginal cancer. These large database analyses provide the epidemiologic framework in the absence of randomized trials. Per ASCO/ESMO practice, definitive CRT (EBRT + brachytherapy + concurrent cisplatin) is used for stage II-IVA, while stage I lesions may be treated with RT alone or surgery depending on tumor location and patient factors.
References