Radiotherapy confers survival advantage in older women with node-positive vulval cancer

Adjuvant radiotherapy after surgery helps improve overall survival in older patients with node-positive vulval cancer, as shown in a study.

The study drew data from the National Cancer Database (NCDB) and included 2,396 patients aged ≥65 years (median age at diagnosis 77 years) who were diagnosed with vulvar squamous cell carcinoma and underwent surgery with confirmed node-positive disease.

Researchers used statistical analysis with propensity-score matching, chi-square test, log-rank test, Kaplan-Meier, and multivariable Cox proportional regression to evaluate whether the survival benefit of adjuvant radiotherapy in patients with node-positive vulvar cancer was maintained in older patients.

Of the patients included in the study, 1,517 (63.3 percent) received adjuvant radiotherapy. The median follow-up was 73 months.

In the propensity score-matched cohort, the 5-year overall survival (OS) in the entire population was 29 percent. Of note, the rate was higher among patients who received surgery followed by adjuvant radiotherapy than among those who received surgery alone (33 percent vs 26 percent; p<0.0001).

Adjuvant radiotherapy was associated with significant survival benefit in the overall population (odds ratio, 0.77, 95 percent confidence interval, 0.69–00.87; p<0.001).

In subgroup analysis, adjuvant radiotherapy vs surgery alone led to improved OS among patients aged 65–84 years (5-year OS: 35 percent vs 29 percent; p=0.0004) but not in those aged ≥85 years (5-year OS: 20 percent vs 19 percent; p=0.32).

The findings indicate that a comprehensive and geriatrics-specific approach is crucial for treating older adults with node-positive vulvar cancer, as the benefit of adjuvant radiotherapy may be compromised by treatment-related morbidity/toxicity, according to the researchers.