Primary invasive cancer of the vagina

The study comprised 63 patients with primary carcinoma of the vagina (PCV) treated between 1964 and 1994 and retrospectively analyses the survival rates and time in relation to various prognostic factors. The overall median age at diagnosis was 64 (range 27–94) years. Forty-one (65%) of the cases were squamous cell carcinomas. The number of patients in various stages were: I/6 (9%), II/34 (54%), III/13 (21%) and IV/10 (16%), and according to histologic dedifferentiation: high grade 23 (37%), medium grade 17 (27%), and low grade 12 (19%); not recorded, 11 (18%). In 12 patients the primary treatment was surgical and five of these patients were operated on a second time at a later occasion (two vaginectomies and 10 vaginal resections); surgical treatment after previous radiotherapy or chemotherapy was given to another 12 patients (four vaginectomies and eight vaginal resections). In summary, 24 (38%) patients were given surgical treatment alone or in combination with other treatment modalities. Fifty-five (87%) patients were treated alone or in combination with other treatment modalities. Fifty-five (87%) patients were treated with external irradiation with a median dose of 40 (range, 21–76) Gray. Fifty (79%) patients were administered brachytherapy with a median dose of 2880 (range, 400–4900) mgRaH. In only eight (13%) patients no radiotherapy was given. Chemotherapy was given to 10 (16%) patients, three of these also received second-line chemotherapy. Chemotherapy after surgical or irradiation therapy was given to six (9%) patients. The 5-year corrected survival rate (5YSR) and median survival time (MST) were 52%/93 months for stage I patients, 50%/30 months for stage II, 24%/10 months for stage III, and 20%/11 months for stage IV. The 5YSR/MST in high grade tumors was 32%/8, in medium grade 36%/13, and in low grade tumors 43%/15 months. The median recurrence-free interval was 18 months (range, 6–94). A trend for better survival was found in patients without a history of serious illness and in a subgroup of patients who were not administered chemotherapy. The most important prognostic factors in this study were tumor stage (P = 0.02), patient age (P = 0.002) and our Prognostic Index (P = 0.01). No differences in survival were found analyzing other patient or tumor characteristics. Of all the patients studied, 14 (22%) are living without evidence of cancer, 10 (16%) have died due to intercurrent disease and 39 (62%) have died of PCV.