A retrospective analysis of 165 patients with histologically confirmed
carcinoma of the vagina is reported. Actuarial disease-free 10-year survival was: Stage 0 (16 patients)--94%, Stage I (50 patients)--75%, Stage IIA (49 patients)--55%, Stage IIB (26 patients)--43%, Stage III (16 patients)--32%, Stage IV (8 patients)--0%. All but one of the in situ lesions were controlled with intracavitary
therapy. Of the patients with Stage I disease, 86% showed no evidence of vaginal or pelvic recurrence. Most of them received interstitial or intracavitary
therapy or both; the addition of external beam irradiation did not significantly increase survival or
tumor control. In Stage IIA (paravaginal extension) 61% of the
tumors were controlled with a combination of
brachytherapy and external beam irradiation. Ten of 16 Stage III
tumors were controlled in the pelvis. Two of the patients with Stage IV disease had no recurrence in the pelvis with relatively high doses of irradiation. The total incidence of distant
metastases was 16% in Stage I, 30.6% in Stage IIA, 46.1% in Stage IIB, 62% in Stage III, and 50% in Stage IV. The dose of irradiation delivered to the primary
tumor or the parametrial extension was critical in achieving successful results. The incidence of grade 2-3 complications (12%) is correlated with the stage of the
tumor and type of treatment given. More effective irradiation techniques including the optimization of dose distribution by judicious combination of external irradiation and interstitial
brachytherapy will be necessary to enhance loco-regional
tumor control. The high incidence of distant
metastases underscores the need for earlier diagnosis and effective systemic
cytotoxic agents if survival is to be significantly improved in these patients.