Vaginal recurrences of @entity1204 : the prognostic value of staging by a primary XXXX system.

@entity1 @entity189 @entity1161 @entity1204
Fifty-five of 1716 @entity1 with @entity1204 seen consecutively at three institutions prior to 1986 were found to have an isolated post-hysterectomy vaginal recurrence. Their therapy included external @entity1161 ( @entity1161 ) and brachytherapy for 26 @entity1 , external @entity1161 alone for 17, brachytherapy only for 4, and no @entity1161 for 8. Combined external @entity1161 /brachytherapy doses ranged from 2000 to 10,000 cGy with a median of 6000 cGy. The 3- and 5-year actuarial survival rates are 48% and 31% for the entire group, and the 3- and 5-year pelvic control rates are 52% and 42%. The 5-year survival and pelvic control rates for those who received greater than or equal to 6000 cGy in total @entity1161 dose are 47% and 68%, compared with 12% and 10% for those receiving less than 6000 cGy (p = 0.002 and p = 0.004). For @entity1 receiving their second @entity1161 course, the 5-year survival rate is 16%, compared with 48% for those not previously irradiated. The Perez modification of the International Federation of Gynecology and Obstetrics (FIGO) staging system for primary @entity189 was applied to each recurrence. There were 15 Stage I cases (vaginal mucosa), 32 Stage II cases divided between 15 Stage IIA (subvaginal infiltration) and 17 in Stage IIB (parametrial infiltration), and 8 Stage III cases (pelvic wall involvement). The 3-year actuarial survival and pelvic control rates using this staging system are: Stage I: 85%/100%; Stage II: 41%/43%, Stage IIA: 59%/53%, Stage IIB: 26%/35%; Stage III: 13%/0%. These outcome endpoints are significantly better for Stage I than Stage II @entity1 (p = 0.01 _ 0.0004) and for Stages I and IIA compared to Stages IIB and III (p = 0.0005 _ 0.002). The pre-treatment variables of age, interval since hysterectomy, initial stage, and location did not predict for survival, but a higher rate of pelvic control was observed for apical than for suburethral recurrences (56% vs. 20%). Grade III histology was highly correlated with poor survival (p = 0.0006). This @entity189 staging system appears to have value in predicting treatment outcome for @entity1 with post-hysterectomy vaginal recurrences.
