Introduction
To evaluate treatment outcomes with image-guided brachytherapy (IGBT) for distal vaginal and vulvar cancers.

Material and methods
Women treated for distal vaginal or vulvar malignancies utilizing IGBT were retrospectively reviewed, and acute and late toxicities were retrospectively graded. Descriptive statistical analysis was performed.

Results
Eighteen patients were included, out of which, twelve patients (66.7%) were with primary disease of the distal vagina and vulva, most commonly squamous cell carcinoma of the vulva (n = 8, 66.7%), and six with recurrent disease, most commonly recurrent endometrial carcinoma (n = 5, 83.3%). All patients received external beam radiation (EBRT) to a median dose of 45 Gy in 25 fractions, followed by IGBT (range of 15 to 27.5 Gy in 3 to 5 fractions). Mean follow-up was 20.6 months. Mean dose to high-risk clinical target volume (HR-CTV) D90 was 72.4 Gy. Mean D2cc for the rectum, bladder, and urethra were 50 Gy, 50.6 Gy, and 62.9 Gy, respectively. Five patients (27.8%) recurred. Three patients (16.7%) had local recurrence, 1 patient (5.6%) had distant recurrence only, and 1 patient (5.6%) had simultaneous regional and distant recurrence. Grade 3 acute toxicities included 1 (5.6%) vaginal stenosis, 6 (33.3%) dermatitis/mucositis, 2 (11.1%) vaginal pain, and 1 (5.6%) vaginal/vulvar infection. Grade 3 late toxicities comprised 3 (17.7%) cases of vaginal pain and 1 (5.9%) skin/vaginal necrosis. There were no grade 4 or higher toxicities.

Conclusions
Definitive radiation therapy in the form of EBRT and IGBT provides meaningful loco-regional control in women with distal vaginal and vulvar cancers, with mainly skin and vaginal toxicity.



中文翻译：

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影像引导近距离放射治疗远端阴道和外阴癌的临床结果

简介
评估图像引导近距离放射治疗 (IGBT) 治疗远端阴道癌和外阴癌的治疗效果。

材料和方法
对使用 IGBT 治疗远端阴道或外阴恶性肿瘤的女性进行回顾性评价，并对急性和晚期毒性进行回顾性分级。进行了描述性统计分析。

结果
纳入 18 例患者，其中 12 例（66.7%）原发于阴道远端和外阴部，最常见的是外阴鳞状细胞癌（n = 8, 66.7%），6 例为复发性疾病，大部分常见的复发性子宫内膜癌（n = 5, 83.3%）。所有患者均接受外束辐射 (EBRT)，中位剂量为 45 Gy，分 25 次，其次是 IGBT（范围为 15 至 27.5 Gy，分 3 至 5 次）。平均随访时间为 20.6 个月。高危临床靶区 (HR-CTV) D90 的平均剂量为 72.4 Gy。直肠、膀胱和尿道的平均 D2cc 分别为 50 Gy、50.6 Gy 和 62.9 Gy。5名患者（27.8%）复发。3例（16.7%）局部复发，1例（5.6%）仅远处复发，1例（5.6%）同时局部和远处复发。3 级急性毒性包括 1 例 (5.6%) 阴道狭窄、6 例 (33.3%) 皮炎/粘膜炎、2 例 (11.1%) 阴道疼痛和 1 例 (5.6%) 阴道/外阴感染。3 级晚期毒性包括 3 例（17.7%）阴道疼痛和 1 例（5.9%）皮肤/阴道坏死。没有 4 级或更高的毒性。

结论
EBRT 和 IGBT 形式的确定性放射治疗为患有远端阴道癌和外阴癌的女性提供了有意义的局部控制，主要是皮肤和阴道毒性。