Introduction/Background*Treatment of vulvar cancer contains surgery if applicable and often primary or neo-/adjuvant chemoradiation. Cisplatin and Mitomycin/5-FU are widely used radiosensitizers in vulvar cancer, although evidence is limited. We retrospectively investigated both radiosensitizers for outcome and toxicity.
Methodology We screened the archive for patients treated with chemoradiation for pathologically-confirmed squamous cell cancer of the vulva between 01/2010 – 02/2021 at our institution. The impact of both radiosensitizers on prognosis was compared using Kaplan-Meier method and Cox-Regression analysis.
Result(s)*127 patients with vulvar cancer were screened. 24 patients received chemoradiation (Cisplatin n=11; Mitomycin/5-FU n=11; others n=2) as a neoadjuvant, primary or adjuvant treatment. Median follow-up was 17 months in both groups. Median age was 65 (35-91) years. Patients in the Cisplatin group were older than in the Mitomycin/5-FU group (Median age 73 vs. 55, p=0.007). Median radiation dose in total was 59.6 (41.4 – 85.0) Gy. 68.2% of the patients had FIGO stage III and 18.2% of the patients had FIGO stage IV before chemoradiation. Both groups showed no differences in terms of FIGO stage.
72.7% (8 out of 11) patients receiving Mitomycin/5-FU achieved clinical complete response compared to 45.5% (5 out of 11) receiving Cisplatin (p=0.309). One patient in each group was progressive during chemoradiation. Three patients stopped chemoradiation due to toxicity (Cisplatin n=2; Mitomycin/5-FU n=1) and one patient in the Cisplatin group died of treatment related sequelae. Radiodermatitis with epitheliolysis were the most common adverse events in both groups. Additionally, four patients in the Mitomycin/5-FU group required treatment for myelotoxicity.
The 2 -year overall survival showed a numerical but not statistically significant difference in favour of the Mitomycin/5-FU group (59.7% vs. 30.7%; p= 0.306). The 2-year-recurrence-free-survival was comparable between Mitomycin/5-FU and Cisplatin (43.6% vs. 31.8%; p=0.829).
Conclusion*Cisplatin and Mitomycin/5-FU showed a numerical but not statistically significant difference in overall survival in vulvar cancer. MitomycinC/5-FU tended to result in a clinical complete response more frequently but required more often a treatment for myelotoxicity. However, overall toxicity of Mitomycin/5-FU was acceptable and may be considered in the treatment of young, healthy patients with locally advanced vulvar cancer.
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