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The role of adjuvant radiation therapy in older patients with node-positive vulvar cancer: A national cancer database analysis

  • Lisa Ni
    Affiliations
    University of California San Francisco, Department of Radiation Oncology, 1600 Divisadero St, Suite H1031, Box 1708, San Francisco, CA 94115, United States of America
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  • Sumi Sinha
    Affiliations
    University of California San Francisco, Department of Radiation Oncology, 1600 Divisadero St, Suite H1031, Box 1708, San Francisco, CA 94115, United States of America
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  • Marianne Rara
    Affiliations
    University of California San Francisco, Department of Radiation Oncology, 1600 Divisadero St, Suite H1031, Box 1708, San Francisco, CA 94115, United States of America
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  • Christina Phuong
    Affiliations
    University of California San Francisco, Department of Radiation Oncology, 1600 Divisadero St, Suite H1031, Box 1708, San Francisco, CA 94115, United States of America
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  • Lee-may Chen
    Affiliations
    University of California San Francisco, Department of Obstetrics and Gynecology and Reproductive Sciences, 1825 Fourth St, Sixth Floor, San Francisco, CA 94158, United States of America
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  • I-Chow J. Hsu
    Affiliations
    University of California San Francisco, Department of Radiation Oncology, 1600 Divisadero St, Suite H1031, Box 1708, San Francisco, CA 94115, United States of America
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  • Emi J. Yoshida
    Correspondence
    Corresponding author.
    Affiliations
    University of California San Francisco, Department of Radiation Oncology, 1600 Divisadero St, Suite H1031, Box 1708, San Francisco, CA 94115, United States of America
    Search for articles by this author
Published:September 20, 2022DOI:https://doi.org/10.1016/j.ygyno.2022.09.009

      Highlights

      • Adjuvant radiotherapy after surgery improves overall survival for node-positive vulvar cancer patients aged 65 and older.
      • For node-positive vulvar cancer patients aged 85 and older, adjuvant radiotherapy provides no survival benefit.
      • A multidisciplinary and geriatrics-based approach best informs treatment for elderly node-positive vulvar cancer patients.

      Abstract

      Objective

      We sought to evaluate whether the survival benefit of adjuvant radiotherapy in patients with node-positive vulvar cancer is maintained in older patients, who comprise a large subgroup of patients with vulvar cancer.

      Methods

      The National Cancer Database (NCDB) was queried for patients aged 65 years or older, who were diagnosed with vulvar squamous cell carcinoma from 2004 to 2017 and underwent surgery with confirmed node-positive disease. Statistical analysis was performed with propensity-score matching, chi-square test, log-rank test, Kaplan-Meier, and multivariable Cox proportional regression.

      Results

      A total of 2396 patients were analyzed, and 1517 (63.3%) received adjuvant radiotherapy. Median follow-up was 73 months. Median age at diagnosis was 77 years (range 65–90). In the propensity score-matched cohort, five-year overall survival (OS) was 29%. Five-year OS was 33% in patients who received surgery followed by adjuvant radiotherapy and 26% in patients who received surgery alone (p < 0.0001). Multivariable analysis continued to demonstrate a survival benefit associated with the addition of adjuvant radiotherapy (OR 0.77 [95% CI 0.69–00.87], p < 0.001). Adjuvant radiotherapy was associated with improved OS among patients aged 65–84 (5-year OS 35% vs 29%, p = 0.0004), but not in patients aged 85 years and older (5-year OS 20% vs 19%, p = 0.32).

      Conclusion

      This NCDB study suggests that in older patients with node-positive vulvar cancer, radiotherapy continues to be a vital component of multimodality therapy. However, a comprehensive and geriatrics-specific approach is crucial for treating older adults with node-positive vulvar cancer, as the benefit of adjuvant radiotherapy may be compromised by treatment-related morbidity/toxicity.

      Keywords

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