Survival and failure types after radiation therapy of vulvar cancer

Background and purpose Describe the survival rates and distribution of events on competing failure types in vulvar carcinoma after treatment with chemoradiation (CRT) or radiation (RT) alone. Material and methods We included patients with vulvar carcinoma treated with CRT or RT between 2009 and 2014. Survival was estimated using the Kaplan-Meier method. We performed a competing risk analysis and included five competing events: loco-regional failure (LRF), distant metastasis, LRF plus distant metastasis, and death without evidence of disease, with the remaining patients denoted alive without evidence of disease. Results 87 patients were treated. Progression free survival (PFS) and overall survival (OS) at 3 years were 40% and 57%, respectively. 41.3% of patients relapsed, most often loco-regionally. We saw significantly worse PFS and OS for patients older than 68 (p = 0.011/p = 0.010) and for patients treated with definitive RT (p = 0.004/p = 0.005). Competing risk analysis showed increased risk of LRF, and that death was most often related to vulvar cancer. Death without disease recurrence was less frequent, even in the elderly. Conclusions LRF was the most common event. PFS and OS were inferior for elderly patients and patients treated definitively. A better understanding of these differences may be used to define risk adapted treatment strategies.