Outcomes after radiation therapy with concurrent weekly platinum-based chemotherapy or every-3–4-week 5-fluorouracil-containing regimens for squamous cell carcinoma of the vulva

ObjectiveTo compare outcomes in patients with squamous cell carcinoma (SCC) of the vulva treated with radiation (RT) and concurrent weekly platinum-based or every-3–4-week regimens containing 5-fluorouracil (5-FU).MethodsRecords of 44 patients with vulvar SCC treated with concurrent chemotherapy and radiation (chemoRT) from 1988 to 2008 were reviewed. Rates of disease-free survival (DFS), overall survival (OS), locoregional recurrence (LRR), and distant metastases (DM) were estimated using the Kaplan–Meier method.ResultsThe median age was 63 years (range, 44–90), 84.1% of patients had ECOG performance status 0–1, and patients had FIGO Stage II (n = 6), III (n = 31), or IVA (n = 7) disease. Patients were treated preoperatively (n = 10), postoperatively (n = 10), or without surgery (n = 24). The median RT dose to the vulva was 50.2 Gray (range, 22–75). Concurrent chemotherapy regimens included weekly platinum (n = 16) or every 3–4 week regimens with 5-FU as the backbone (n = 28).With a median follow-up of 31.5 months, there was no significant difference in 2-year OS (74.5% vs. 70.0%; p = 0.65), DFS (61.9% vs. 56.0%; p = 0.85), LRR (31.3% vs. 32.9%; p = 0.93), or DM (6.3% vs. 10.6%; p = 0.81) between the weekly platinum and every-3–4-week 5-FU regimens. Twenty patients (45.4%) recurred: 16 LRR, 2 DM, and 2 with both. The clinical and pathologic complete response rates were 58.8% (20/34), and 53.8% (14/26), respectively. There was a higher proportion of grade 3 or higher acute non-skin toxicities in patients receiving every-3–4-week 5-FU (46.1% vs. 13.3%; p = 0.07), but more grade 3 or higher skin toxicity in patients receiving weekly platinum (62.5% vs. 32.0%; p = 0.01).ConclusionOS, response rates, and recurrence rates were not significantly different after RT with concurrent weekly platinum-based versus every-3–4-week regimens containing 5-FU for vulvar SCC.

Research Highlights
► Retrospective study of two chemoRT regimens for vulvar squamous cell cancer.
► Compared outcomes after weekly platinum or q3-4-week 5-FU regimens.
► No difference in locoregional control, distant recurrence rates or overall survival.
► Higher skin toxicity with weekly platinum, but higher non-skin toxicity with 5-FU.