Role of Radiation Therapy in the Management of Locally Advanced Vulvar Cancer-15 Years of Experience at a Tertiary Care Center in Southern India.

Vulvar carcinoma represents 3-5% of all gynecological malignancies and 1% of female cancers. Primary surgical excision is the cornerstone of treatment for early-stage invasive disease. Adjuvant radiation therapy reduces the risk of local recurrence in patients with high-risk features, and radical chemoradiation is an option for locally advanced vulvar cancer. This retrospective study aimed to analyze the clinical presentation, treatment details, outcomes, patterns of failure, and possible prognostic factors. We reviewed the electronic medical records of 53 patients diagnosed with carcinoma of the vulva from January 2005 to December 2020. All patients with biopsy-proven carcinoma of the vulva who received radiation therapy with or without surgery were included in the study. The median age at presentation was 59 years (range 35-85 years). The most common stage at presentation was Stage III (37.7%, n = 20), followed by Stage IB (22.6%, n = 12). Thirty patients (56.6%) underwent surgery, and the majority (76.7%) underwent radical vulvectomy with bilateral inguinofemoral block dissection. Nineteen patients (55.9%) received adjuvant radiation therapy for various indications, such as close margins, positive margins, or positive nodes. Twenty patients (37.7%) received definitive chemoradiation therapy, for a median dose of 66 Gy in 33 fractions. Acute toxicity in the form of Grade 3 dermatitis was observed in 19 out of 45 patients (42.2%) who received RT, and late toxicity in the form of lymphedema was observed in 5 patients (11.1%). The median follow-up was 20 months (0-170 months). At follow-up, 25 patients (47.1%) were disease free or had stable disease, 14 patients (26.4%) had local or inguinal nodal recurrence or progression, 2 patients (3.7%) had metastatic disease (lung, mediastinal node), and 13 patients (24.5%) were lost to follow-up. The median progression-free survival (PFS) was 24 months (95% CI 17.2 to 30.8 months), and the median overall survival (OS) was 29 months (95% CI 21-37 months). Radical surgery followed by adjuvant radiation therapy led to superior outcomes in terms of progression-free survival (p = 0.0001) and overall survival (p = 0.005). Radical surgery followed by adjuvant radiation therapy was associated with the most favorable PFS and OS. Definitive chemoradiation therapy with modern radiation techniques is an alternative to radical surgery for medically/surgically inoperable locally advanced vulvar cancer patients and has favorable outcomes and toxicity profiles. Given the rarity of vulvar carcinoma, further research and multicenter studies are warranted to enhance our understanding of this malignancy and optimize treatment strategies to improve patient outcomes.