Exclusive radiotherapy for primary squamous cell carcinoma of the vagina

Radiother Oncol. 2007 Dec;85(3):362-70. doi: 10.1016/j.radonc.2007.09.015. Epub 2007 Oct 25.


Purpose: To retrospectively analyze results of external beam therapy (EBT) with brachytherapy (BT) for primary vaginal squamous cell carcinoma (PVSCC).

Materials and methods: From 1970 to 2001, 91 patients were included. FIGO stages were: I (29%), II (38%), III (29%) and IVa (4%). EBT delivered a median total dose of 50 Gy to the pelvis. BT was performed with a customized intra-vaginal applicator and in 36% of applications combined endocavitary and interstitial BT. ICRU Report 38 parameters were reported.

Results: The 5-year cause specific survival (CSS) rates were: 83% for stage I, 76% for stage II, 52% for stage III, and 2 of the 4 stage IVa patients died 9 and 36 months after treatment. The 5-year pelvis control rates were: 79% for stage I and II and 62% for stage III. Recurrences as a first event were local only in 68% of cases, nodal only in 10%, metastatic only in 13% and combined in 9%. In multivariate analysis: stage (I and II versus II and IV), response to EBT (evaluated at BT), and the number of BT applications were statistically significant for CSS. Grade 2-3 toxicities were as follows (Franco-Italian Glossary): rectum (n=3), sigmoid colon and small bowel (n=8), bladder (n=5), ureter (n=4) and vagina (n=13). Anterior location of the tumor increased bladder toxicity (p=0.01) and total reference air kerma was higher in patients who experienced grade 2-3 urinary or digestive toxicity (p=0.03).

Conclusion: EBT with BT is an effective treatment for patients with stage I-II PVSCC. The incidence and severity of late toxicity were relatively low. Recent advances in the treatment of cervix carcinoma emphasize the need for concomitant radio-chemotherapy in stages III-IV and the use of MRI for treatment planning.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Brachytherapy* / methods
  • Carcinoma, Squamous Cell / mortality
  • Carcinoma, Squamous Cell / radiotherapy*
  • Female
  • Humans
  • Middle Aged
  • Neoplasm Metastasis
  • Neoplasm Recurrence, Local
  • Radiotherapy / adverse effects
  • Radiotherapy Dosage
  • Retrospective Studies
  • Survival Rate
  • Vaginal Neoplasms / mortality
  • Vaginal Neoplasms / radiotherapy*