Vulvar Recurrences After Intensity-modulated Radiation Therapy for Squamous Cell Carcinoma of the Anus

• Published in: American journal of clinical oncology Vol. 41; no. 5; p. 492
• Main Authors: Bagshaw, Hilary P, Sause, William T, Gawlick, Ute, Kim, H Tae, Whisenant, Jonathan, Cannon, George M
• Format: Journal Article
• Language: English
• Published: United States 01.05.2018
• Subjects: Anus Neoplasms - pathology; Anus Neoplasms - radiotherapy; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - radiotherapy; Female; Follow-Up Studies; Humans; Middle Aged; Prognosis; Radiotherapy Dosage; Radiotherapy, Intensity-Modulated - adverse effects; Recurrence; Retrospective Studies; Survival Rate; Vulvar Neoplasms - diagnosis; Vulvar Neoplasms - secondary
• ISSN: 1537-453X
• DOI: 10.1097/COC.0000000000000322

The objective is to determine localregional control (LRC), distant metastasis free survival, disease-free survival, overall survival (OS), and toxicity for patients with squamous cell carcinoma of the anus treated with definitive chemotherapy and intensity-modulated radiation therapy (IMRT). We conducted a retrospective review of patients treated using IMRT for squamous cell carcinoma of the anus at our institution since 2005. Patients with local recurrences were identified and reviewed. The Kaplan-Meier curves were used for LRC and OS. From 2005 to 2014, 52 patients were treated with IMRT-based chemoradiation for squamous cell carcinoma of the anus. Median dose to the primary tumor was 54 Gy. LRC, distant metastasis free survival, OS, and disease-free survival were 92.3%, 88.5%, 86.5%, and 84.6%, respectively, with a median follow-up of 20 months. Two local failures occurred at the anal primary site and 2 in the vulva. Despite subsequent palliative radiotherapy and chemotherapy, neither patient with a vulvar recurrence achieved disease control. In a cohort of patients treated with IMRT-based chemoradiation, 2 vulvar recurrences were identified within the avoided external genitalia despite limited recurrence rates within the cohort overall. This experience suggests that for patients with a locally advanced primary tumor and bulky bilateral inguinal or pelvic disease, the in-transit vulvar dermal lymphatics may be at risk for subclinical involvement and subsequent recurrence. If substantiated by a similar pattern of recurrence at other institutions, the external genitalia may need to be reclassified from an avoidance structure to a clinical treatment volume in patients with locally advanced anal cancer.