Chemo and IMRT Leads to Promising Outcomes in Vulvar Cancer

Treatment with two types of chemotherapy plus intensity-modulated radiation therapy (IMRT) led to nearly three-fourths of patients with vulvar cancer being rid of any signs and symptoms of cancer, a study showed.

Specifically, treatment with chemotherapies, cisplatin and gemcitabine, plus IMRT improved complete pathological responses (CPR; response when patients no longer have any signs or symptoms of cancer), stated a study from the Journal of Clinical Oncology.

The study included 52 patients with vulvar cancer who were not eligible to have their cancer surgically removed. The researchers found that of the 52 patients, 38 (73%) reached CPR.

Additionally, at a median follow-up of 51 months, the progression-free survival (PFS; when patients live without their disease worsening) was 74% at 12 months, the study demonstrated. The overall survival (OS; time patients live before death of any cause) at 24 months was 70%.

This treatment regimen also “decreases the toxicity and allows higher doses of radiation to be given,” said Dr. Neil Horowitz during an interview with CURE®. Horowitz is a co-author of the study and surgical oncologist at Dana-Farber Cancer Institute and Brigham and Women’s Hospital in Boston.

Horowitz emphasized that using IMRT could achieve more because “theoretically, you can get more tumor kill.”

According to the National Cancer Institute, IMRT is a type of three-dimensional radiation therapy that precisely aims thin beams at the tumor.

“What's unclear from the study is whether that improvement in the complete pathologic response rate was due to the addition of gemcitabine, or whether it was the use of IMRT. For that reason, I think [if patients are] going to [receive] this kind of regimen, it probably should be the two [chemotherapy] drugs with the IMRT,” Horowitz said.

It's important for patients to note that the study did not identify whether patients had human papillomavirus infection (HPV) or non-HPV-related vulvar cancers, Horowitz emphasized. He explained that this is important because typically, HPV-related cancers “respond even better to radiation and chemotherapy than non-HPV-related cancers do.”

Traditional Treatment for Patients With Vulvar Cancer

Traditional treatment for patients with vulvar cancer who could not receive surgery, Horowitz noted, was “a little more chemo” and a “slightly different radiation technique.”

“The radiation side effects of treatments are pretty common, but probably less so with the IMRT than with traditional radiation therapy,” he said.

Common side effects from traditional radiation included radiation dermatitis, Horowitz mentioned. According to the Cleveland Clinic, radiation dermatitis is caused by the external beams from radiation, leaving the skin sore. Other symptoms may include peeling, itching and redness like a sunburn.

In the study, researchers reported that the most common grade 3 and 4 (severe and life-threatening) side effects included low blood cell counts and radiation dermatitis. Some of the other side effects that were not as severe included urologic toxins and bladder toxicity, Horowitz added.

He explained that despite the grade 3 and 4 side effects among patients in the study, “the vast majority of people still completed the prescribed regimen. So even though there was some toxicity, it was easily managed.”

However, based on the results of the study Horowitz advised patients to ask their doctors about IMRT as an option for treatment.

“[For patients], just making sure that their radiation oncologist is using IMRT,” he said. “I think that for otherwise healthy patients, using the combination of gemcitabine and cisplatin may be really important to improving their complete pathologic response rate.”

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