Keisuke Tsuchida

Clinical outcomes and prognostic factors of adjuvant radiotherapy for vulvar cancer: a Japanese Gynecologic Oncology Group nationwide survey study

Abstract This study aimed to analyze the clinical outcomes and prognostic factors of postoperative adjuvant radiotherapy (RT) for vulvar cancer based on a retrospective Japanese nationwide survey. Data were collected from 108 institutions for patients diagnosed with vulvar cancer between January 2001 and December 2010. Patients with histologically confirmed squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma who underwent curative surgery and adjuvant radiotherapy were included in this study. Survival outcomes were estimated using the Kaplan–Meier method, and prognostic factors were analyzed via univariate and multivariate models. A total of 139 patients were included, with a median follow-up of 44 months (range: 3–169). The 5-year overall survival (OS) rates (95% confidence interval [CI]) for stages I, II, III, and IV were 71.8% (50.8–92.8%), 61.3% (40.1–82.5%), 58.0% (45.8–70.2%), and 47.3% (27.5–67.1%), respectively. The corresponding 5-year cause-specific survival (CSS) rates (95% CI) for stages I, II, III, and IV were 71.8% (50.8–92.8%), 73.4% (53.0–93.8%), 62.2% (50.0–74.4%), and 47.3% (27.5–67.1%). Multivariate analysis identified age ≥70 years as an independent adverse prognostic factor for OS (hazard ratio [HR]: 1.848; 95% CI: 1.039–3.281; P = 0.042), while the presence of ≥2 inguinofemoral lymph node metastases was significantly associated with poorer CSS (HR: 2.179; 95% CI: 1.109–4.280; P = 0.030). Our analysis identified advanced age and a higher nodal burden as significant predictors of poorer survival outcomes in patients with vulvar cancer receiving postoperative adjuvant RT.

Significance of definitive concurrent chemoradiotherapy for vulvar cancer: a Japanese Gynecologic Oncology Group nationwide survey study

Abstract Objective This study aimed to show the results of radical radiation therapy (RT) and concurrent chemoradiotherapy (CCRT) for vulvar cancer (VC) based on data from a Japanese nationwide survey. Materials and methods We collected data from 108 institutions on cases of VC diagnosed between January 2001 and December 2010. Patients with histologically proven squamous cell carcinoma and adenocarcinoma with curative intent were selected, and 172 patients with VC were included in this study. The collected data were analyzed for overall survival (OS) using the Kaplan–Meier method. Univariate and multivariate analyses were performed to examine the prognostic factors for patients with VC. Results The median follow-up period was 16.8 (range; 3.2–154.8) months. Fifty-five patients received CCRT, and 117 patients received RT alone. The 2-year OS rates (95% confidence interval [CI]) for stages I, II, III, and IV were 77.9% (55.8–100.0), 71.9% (53.8–89.9), 55.4% (42.5–68.3), and 41.5% (27.3–55.7) respectively. Univariate analyses showed that the FIGO stage (p = 0.001), tumor diameter (p = 0.005), and lymph node (LN) status (p = 0.001) were associated with OS. The concurrent use of chemotherapy resulted in a significantly longer OS in Stage III (p = 0.013). Multivariate analysis showed that the hazard ratios (95% CI) for tumor diameter, positivity for LN metastasis, and RT alone (no concurrent chemotherapy) were 1.502 (1.116–2.021), 1.801 (1.287–2.521), and 1.936 (1.187–3.159), respectively. Conclusions Our analysis revealed that CCRT should be recommended, especially for Stage III VC patients. Further studies are warranted to determine who benefits from CCRT, considering primary tumor size and LN status. The study was registered at the University Hospital Medical Information Network (protocol number: UMIN000017080) on April 8th, 2015.