Treatment/Prognosis Flashcards
What are 3 appropriate Tx options for vaginal intraepithelial neoplasia (VAIN)?
Surgical excision, laser vaporization, and topical 5-FU are all appropriate Tx for VAIN.
VAIN is multifocal in what % of pts?
Up to 60% of pts with VAIN have multifocal Dz. Close f/u is essential.
In general, what is the preferred definitive Tx modality for vaginal cancer?
Although Sg may be appropriate for early, stage I lesions, definitive RT is generally the preferred Tx modality (as morbidity is less compared with radical Sg).
What are the estimates of 5-yr pelvic Dz control and DSS for stages I, II, and III–IVA vaginal cancer managed with definitive RT?
For vaginal cancer managed with definitive RT, 5-yr pelvic Dz control is 86%, 84%, and 71% for FIGO stages I, II, and III–IVA, respectively. 5-yr DSS is 85%, 78%, and 58%, respectively. (Frank SJ et al., IJROBP 2005)
Is concurrent CRT a reasonable consideration in advanced-stage vaginal cancer?
Yes. Extrapolating from the cervical, vulvar, and anal cancer literature, concurrent CRT (typically, cisplatin-based) is reasonable to consider for advanced-stage vaginal cancer (i.e., stages III–IVA).
Is vaginal cylinder brachytherapy alone (without EBRT) appropriate in any vaginal cancer pts?
Possibly. Although whole pelvis EBRT combined with brachytherapy is generally preferred, vaginal cylinder brachytherapy alone may be acceptable for pts with VAIN or very early stage I vaginal cancer <5-mm thick.
What brachytherapy technique is commonly required for stages II–III vaginal cancer (in addition to EBRT Tx)? How important is it to include brachytherapy?
Interstitial brachytherapy needle implants are commonly required to achieve adequate brachytherapy dose coverage for stages II–III vaginal cancers (the depth–dose characteristics of intracavitary applicators are not favorable enough to treat deep lesions).
Recently published SEER analysis (Orton A et al., Gynecol Oncol 2016) compared pts with primary vaginal cancer treated with EBRT alone vs. EBRT with brachtherapy. All FIGO stages benefited with a reduced rate of death by more than 20%.
Describe the regions that are targeted in whole pelvis RT for vaginal cancer.
A whole pelvis field for vaginal cancer typically targets the common, internal, and external iliac nodes, obturator nodes, and the entire vagina (or 3 cm below the Dz extent). If the lower-third of the vagina is involved, then the inguinal nodes may be targeted as well (as per vulvar or anal cancer).
What are the appropriate EB and cumulative (EB + brachytherapy) RT doses for vaginal cancer?
Whole pelvis (+/– inguinal nodes) EB doses are typically 45–50 Gy → brachytherapy boost to a total dose of 65–75 Gy. 70–80 Gy has been recommended when RT alone (without chemo) is used.
Among pts who fail following definitive RT, what % have LR as a component of their relapse?
∼75% of pts with relapse following definitive RT for vaginal cancer will experience LF. (Frank SJ et al., IJROBP 2005)
