Patterns of care for locally advanced vulvar cancer

• Published in: American journal of obstetrics and gynecology 2013-07, Vol.209 (1), p.60.e1-60.e5
• Main Authors: Sharma, Charu, MD, Deutsch, Israel, MD, Herzog, Thomas J., MD, Lu, Yu-Shiang, MS, Neugut, Alfred I., MD, PhD, Lewin, Sharyn N., MD, Chao, Clifford K., MD, Hershman, Dawn L., MD, Wright, Jason D., MD
• Format: Article
• Language: English
• Subjects: Adult; advanced vulvar carcinoma; Aged; Carcinoma, Squamous Cell - drug therapy; Carcinoma, Squamous Cell - radiotherapy; Carcinoma, Squamous Cell - surgery; Carcinoma, Squamous Cell - therapy; Chemoradiotherapy, Adjuvant - trends; Chemoradiotherapy, Adjuvant - utilization; Female; Humans; Logistic Models; Middle Aged; morbidity; neoadjuvant chemoradiation; Obstetrics and Gynecology; Radiotherapy - trends; Radiotherapy - utilization; SEER Program; surgery; United States; vulvar cancer; Vulvar Neoplasms - drug therapy; Vulvar Neoplasms - radiotherapy; Vulvar Neoplasms - surgery; Vulvar Neoplasms - therapy; vulvectomy
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2013.03.013

Objective Patients with locally advanced vulvar carcinoma can be treated with primary surgery or neoadjuvant chemoradiation. Neoadjuvant treatment appears to be associated with decreased morbidity and acceptable long-term outcomes. We examined the patterns of care for women with locally advanced vulvar cancer. Study Design Data from the Surveillance, Epidemiology, and End Results (SEER) database was used to examine women with stage III-IVA vulvar cancer treated from 1988 to 2008. Primary therapy was classified as surgery or radiation. Multivariable logistic regression models were developed to examine the use of primary radiotherapy. Results We identified a total of 2292 women including 1757 who underwent primary surgery (76.7%) and 535 treated with primary radiation (23.3%). The use of primary radiation increased with time from 18.0% in 1988 to 30.1% in 2008. In a multivariable model, older women (odds ratio [OR], 1.33; 95% confidence interval [CI], 1.03–1.72), black women (OR, 1.59; 95% CI, 1.14–2.23), and patients with stage IVA tumors (OR, 2.23; 95% CI, 1.78–2.81) were more likely to receive primary radiation. Among women treated with primary radiotherapy, only 17.8% ultimately underwent surgical resection. Conclusion The use of primary radiation for locally advanced vulvar cancer is limited but has increased over time. Multiple patient and tumor factors influence use. The majority of patients with stage III-IVA vulvar cancer treated with primary radiation therapy did not undergo surgical resection.