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2022-RA-1162-ESGO Proactive management in vulvar radiotherapy facilitates treatment completion
  1. Inbal Golomb1,
  2. Eliya Shachar2,
  3. Dorin Berman1,
  4. Adi Davidovitch1,
  5. Yasmin Korzetz1,
  6. Yasmin Natan Oz1 and
  7. Tatiana Rabin1
  1. 1Radiation Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
  2. 2Medical Oncology, Tel Aviv Medical Center, Tel Aviv, Israel


Introduction/Background Vulvar carcinoma is a rare malignancy, accounting for 4% of gynecological malignancies. Radiotherapy is commonly used and highly effective yet associated with severe adverse effects and psychological implications which limit treatment completion.Only 50% of patients complete the radiotherapy planned treatment(>20 fractions,duration <8 weeks and <1 week of break).Guidelines for management and supportive care during radiotherapy for vulvar carcinoma are lacking.

Methodology We retrospectively analyzed medical charts of patients who underwent radiotherapy for vulvar carcinoma from October 2018-December 2021.

Results Among 17 patients treated at our institution, 8 received definitive therapy, 8 adjuvant treatment, and 1 palliative radiation. Radiation doses ranged from 36–66Gy. Seven patients were treated with an electron boost, 2 with a brachytherapy boost. The most common side effects included local pain, requiring analgesics and cannabis among 12 women and skin burns in 15 women, 5 had grade III burns, of which one required hyperbaric oxygenation.

In an effort to facilitate treatment completion, a proactive approach was employed, including instruction and guidance regarding the treatment process prior to initiation. Close monitoring entailing weekly physician visits, and with the onset of adverse events, more intense 2–3 assesments per week were instituted, focusing on pain alleviation. In an effort to ease the emotional burden and anxiety, patients were supported by a social worker and psychologist. Treatment breaks were initiated by physician prior to severe burn development in order to prevent longer breaks or cessation of radiotherapy. Eleven patients had physician-initiated breaks, with an average duration of 4.3 days. Four women had breaks over 1 week (median 9.5 days), all in the definitive treatment setting. All patients completed the treatment regimen. With an average follow-up of 13.5 months, half of the patients had no evidence of disease.

Conclusion Our institutional experience comprising intensive clinical and emotional management of vulvar carcinoma radiotherapy provides a proactive approach involving frequent assessment, initiated breaks and emotional support, all facilitating improvement in historically low treatment compliance.

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