Increasing utilization of intensity modulated radiation therapy in vulvar cancer: National Practice Patterns 2004–2012

Abstract

Objective

The aim of this study is to evaluate utilization of intensity modulated radiation therapy (IMRT) for vulvar cancer between 2004 and 2012, and determine the survival impact of IMRT and 2D/3D radiation therapy (RT) for women treated with postoperative, preoperative, or primary radiation.

Methods

Women with vulvar carcinoma who received IMRT or 2D/3D RT were identified in the National Cancer Data Base (NCDB) between 2004 and 2012. Patient characteristics were compared between those that received IMRT and 2D/3D RT using chi-square, Fisher's exact, and Mann-Whitney tests. Women were stratified by treatment approach, and overall survival (OS) was estimated via the Kaplan-Meier method and compared using the log-rank test. Factors associated with OS were determined using univariate and multivariate Cox proportional hazards regression models.

Results

A total of 6027 women were included (median age 67 years). Women received either 2D/3D RT (n = 4723) or IMRT (n = 1304). A total of 3.3% of women received IMRT in 2004, compared to 19.3% in 2008 and 43.0% in 2012. More women in the IMRT cohort received radiation doses >55 Gy compared to the 2D/3D RT cohort (47.5 vs. 40.3%, p < 0.001). Women received postoperative radiation (n = 3395), preoperative radiation (n = 478), or primary radiation (n = 1852). On multivariate analyses, the effect of radiation technique (IMRT vs. 2D/3D RT) on OS among women receiving post-operative, pre-operative, or primary radiation was not significant (p > 0.05).

Conclusions

IMRT utilization for vulvar cancer increased between the years 2004 and 2012. Survival was not significantly compromised with the use of IMRT compared to conventional 2D/3D RT techniques and may have allowed for dose escalation in some situations.

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