Abstract
Objective
Definitive radiation therapy (RT), using external beam RT and/or brachytherapy, is a standard treatment option for primary vaginal carcinoma. However, this treatment has poor prognosis when applied to vaginal nonsquamous cell carcinoma (non-SCC). We aimed to clarify treatment outcome and surgical safety in early-stage primary vaginal non-SCC.
Methods
After receiving approval from the institutional review board, we retrospectively reviewed the clinical records and pathological samples of patients treated at our hospital between 1991 and 2018. Among 49 patients with primary vaginal carcinoma, 12 with histologically confirmed early-stage primary vaginal non-SCC were included in this study.
Results
In total, 40% of patients with primary vaginal carcinoma treated at our hospital had primary vaginal non-SCC. The average observation time was 34 months (median 53.3 months). Three patients had local recurrence: 2 in pelvic lymph nodes and 1 in the vagina. Furthermore, 2 patients died of their disease. Five-year local control rate of stage I and stage II non-SCC was 75% and 100%, respectively. Disease-specific survival rate of stage I and stage II non-SCC was 81.8% and 100%, respectively. No major morbidity was observed. Three patients required allogeneic blood transfusion, whereas 1 underwent autotransfusion. None of the 12 patients were discharged with self-catheterization.
Conclusion
Five-year local control and disease-specific survival rates of patients surgically treated for vaginal non-SCC were favorable. Therefore, surgery could be a safe and reasonable option for early-stage primary vaginal non-SCC.
Similar content being viewed by others
References
Bray F, Ferlay J, Soerjomataram I et al (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68:394–424
Wu X, Matanoski G, Chen VW et al (2008) Descriptive epidemiology of vaginal cancer incidence and survival by race, ethnicity, and age in the United States. Cancer 113:2873–2882
Frank SJ, Jhingran A, Levenback C et al. (2005) Definitive radiation therapy for squamous cell carcinoma of the vagina. Int J Radiat Oncol Biol Phys 62:138–147
Kucera H, Mock U, Knocke TH et al (2001) Radiotherapy alone for invasive vaginal cancer: outcome with intracavity high dose rate brachytherapy versus conventional low dose rate brachytherapy. Acta Obstet Gynecol Scand 80:355–360
Orton A, Boothe D, Williams N et al (2016) Brachytherapy improves survival in primary vaginal cancer. Gynecol Oncol 141:501–506
Guerri S, Perrone AM, Buwenge M et al (2019) Definitive radiotherapy in invasive vaginal carcinoma: a systematic review. Oncologist 242:132–141
Frank SJ, Deavers MT, Jhingran A et al (2007) Primary adenocarcinoma of the vagina not associated with diethylstilbestrol (DES) exposure. Gynecol Oncol 105:470–474
Chyle V, Zagars GK, Wheeler JA et al (1996) Definitive radiotherapy for carcinoma of the vagina: outcome and prognostic factors. Int J Radiat Oncol Biol Phys 35:891–905
Herbst AL, Ulfelder H, Poskanzer DC (1971) Adenocarcinoma of the vagina. Association of maternal stilbestrol therapy with tumor appearance in young women. N Engl J Med 284:878–881
Noller KL, Decker DG, Lanier AP et al (1972) Clear-cell adenocarcinoma of the cervix after maternal treatment with synthetic estrogens. Mayo Clin Proc 47:629–630
Senekjian EK, Frey KW, Anderson D et al (1987) Local therapy in stage I clear cell adenocarcinoma of the vagina. Cancer 60:1319–1324
Senekjian EK, Frey KW, Stone C et al (1988) An evaluation of stage II vaginal clear cell adenocarcinoma according to substages. Gynecol Oncol 31:56–64
Plesinac-Karapandzic V, Stojanovic Rundic S, Jankovic R et al (2017) Non-diethylstilbestrol exposed vaginal adenocarcinoma in young patients associated with unilateral renal agenesis: two case reports and literature review. Eur J Gynaecol Oncol 38:157–161
Nomura H, Matoda M, Okamoto S et al (2015) Clinical characteristics of non-squamous cell carcinoma of the vagina. Int J Gynecol Cancer 25:320–324
Tjalma WA, Monaghan JM, de Barros LA et al (2001) The role of surgery in invasive squamous carcinoma of the vagina. Gynecol Oncol 81:360–365
Jain Y, Sekhon R, Giri S et al (2016) Role of radical surgery in early stages of vaginal cancer: our experience. Int J Gynecol Cancer 26:1176–1181
Stock RG, Chen AS, Seski J (1995) A 30-year experience in the management of primary carcinoma of the vagina: analysis of prognostic factors and treatment modalities. Gynecol Oncol 56:45–52
Creasman WT, Phillips JL, Menck HR (1998) The national cancer data base report on cancer of the vagina. Cancer 83:1033–1040
Beller U, Maisonneuve P, Benedet JL et al (2003) Carcinoma of the vagina. Int J Gynaecol Obstet 83:27–39
Perez CA, Grigsby PW, Garipagaoglu M et al (1999) Factors affecting long-term outcome of irradiation in carcinoma of the vagina. Int J Radiat Oncol Biol Phys 44:37–45
TabataT TN, Nishida H, Hirai Y et al (2002) Treatment failure in vaginal cancer. Gyecol Oncol 84:309–314
Kirkbride P, Fyles A, Rawlings GA et al (1995) Carcinoma of the vagina—experience at the Princess Margaret Hospital (1974–1989). Gynecol Oncol 56:435–443
Li Y, Chen Y, Xu H et al (2012) Laparoscopic nerve-sparing radical vaginectomy in patients with vaginal carcinoma: surgical technique and operative outcomes. J Minim Invasive Gynecol 19:593–597
de Crevoisier R, Sanfilippo N, Gerbaulet A et al (2007) Exclusive radiotherapy for primary squamous cell carcinoma of the vagina. Radiother Oncol 85:362–370
Tran PT, Su Z, Lee P et al (2007) Prognostic factors for outcomes and complications for primary squamous cell carcinoma of the vagina treated with radiation. Gynecol Oncol 105:641–649
Sinha B, Stehman F, Schilder K et al (2009) Indiana university experience in the management of vaginal cancer. Int J Gynecol Cancer 19:686–693
Hiniker SM, Roux A, Murphy JD et al (2013) Primary squamous cell carcinoma of the vagina: prognostic factors, treatment patterns, and outcomes. Gynecol Oncol 131:350–355
Nonaka T, Nakayama Y, Mizoguchi N et al (2013) Definitive radiation therapy for invasive carcinoma of the vagina: impact of high-dose rate intracavitary brachytherapy. Int J Clin Oncol 18:314–320
Greenwalt JC, Amdur RJ, Morris CG et al (2015) Outcomes of definitive radiation therapy for primary vaginal carcinoma. Am J Clin Oncol 38:583–587
Laliscia C, Fabrini MG, Delishai D et al (2016) Concomitant external-beam irradiation and chemotherapy followed by high-dose rate brachytherapy boost in the treatment of squamous cell carcinoma of the vagina: a single center retrospective study. Anticancer Res 36:1885–1889
Chang JH, Jang WI, Kim YB et al (2016) Definitive treatment of primary vaginal cancer with radiotherapy: multi-institutional retrospective study of the Korean Radiation Oncology Group (KROG 12–09). J Gynecol Oncol 27:e17
Guerri S, Perrone AM, Buwenge M et al (2019) Definitive radiotherapy in invasive vaginal carcinoma: a systematic review. Oncologist 24:131–141
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors state that they have no potential conflicts of interest to disclose.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Nomura, H., Tanaka, Y., Omi, M. et al. Surgical outcomes of early-stage primary vaginal nonsquamous cell carcinoma. Int J Clin Oncol 25, 1412–1417 (2020). https://doi.org/10.1007/s10147-020-01663-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10147-020-01663-4