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Outcomes of locally advanced vulvar cancer patients treated with definitive concurrent chemoradiation at Groote Schuur Hospital from January 2008 – January 2020.
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2025
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University of Cape Town
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Abstract
Vulvar cancer is a relatively rare gynaecological malignancy. In both South Africa and globally, the high prevalence of HIV, coupled with the increased incidence of human papillomavirus (HPV), has been associated with a rising occurrence of vulvar cancer in younger women. In low- and middle-income settings, limited access to healthcare frequently results in patients presenting with advanced-stage disease. Consequently, vulvar cancer may become inoperable, necessitating alternative treatment strategies such as definitive radiotherapy in combination with concurrent chemotherapy. This review seeks to evaluate overall and disease-free survival, while also examining factors that may influence survival in patients with locally advanced vulvar cancer who received concurrent chemoradiation. Methods: A retrospective audit was conducted to evaluate the clinical data of patients who received chemoradiation for locally advanced vulvar cancer at Groote Schuur Hospital between January 2008 and January 2020. The data collected encompassed patient age, HIV status, FIGO 2021 cancer stage, ECOG performance status, overall survival (OS), disease-free survival (DFS), treatment response, and detailed treatment specifics. Results: A total of 29 participants met the eligibility criteria for this study, with a mean age of 48 years. The median OS for the cohort was 41.0 months (95% CI 11.61–70.39 months), while the median DFS was 21.0 months (95% CI 4.63–37.38 months). Regarding HIV status, 14 participants (48%) were HIV-positive, of whom 10 (71%) were on antiretroviral therapy (ART). Based on the FIGO 2021 staging system, 6 participants (21%) presented with stage II disease, whereas the majority, 23 participants (79%), were diagnosed with stage III/IVA vulvar cancer. Five-year OS was 71% for those with earlier-stage disease, compared to 32% for those with later-stage disease (HR: 2.14, p=0.33).In terms of treatment response, 15 participants (52%) achieved a complete response, 11 (38%) had a partial response, and 3 (10%) experienced disease progression. Notably, participants with a complete response exhibited a significantly higher 5-year OS rate of 68%, compared to 0% among those with partial response or progressive disease (HR: 0.11, p<0.001). DFS outcomes were similarly significant, with a 5-year DFS rate of 46% in the complete response group versus 0% in the partial response/progression group (HR: 0.16, p=0.002). Conclusion: The survival outcomes for women treated with concurrent chemoradiation at Groote Schuur Hospital were suboptimal. Several factors likely influenced these outcomes, including age at presentation, HIV status, disease stage at diagnosis, and rates of treatment completion and response. Notably, patients who achieved a complete response to treatment exhibited significantly improved survival outcomes compared to those with only a partial response.
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Sayed, A. 2025. Outcomes of locally advanced vulvar cancer patients treated with definitive concurrent chemoradiation at Groote Schuur Hospital from January 2008 – January 2020. . University of Cape Town ,Faculty of Health Sciences ,Division of Radiology. http://hdl.handle.net/11427/42799