2777 - The Landscape of Vulvar Cancer: Treatment Characteristics and Survival in Botswana
Presenter(s)
H. Khalil1, C. Kernell1, B. Tortelli2, S. Amoo-Mitchual3, K. Hughes4, M. Kassick3, M. Anchondo1, G. Moorkanat3, D. Kwamboka3, E. Corn3, B. Monare5, R. Ketlametswe5, S. Hakim3, M. Tafadzwa5, W. Oyegoke5, P. Vuylsteke6,7, J. A. O. Díaz8, L. Bazzett Matabele6, M. Nsingo8, and S. Grover5,9; 1University of Texas at Southwestern Medical School, Dallas, TX, 2Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, 3University of Pennsylvania, Philadelphia, PA, 4Oklahoma College of Medicine, Oklahoma City, OK, 5Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, 6University of Botswana, Gaborone, Botswana, 7Princess Marina Hospital, Gaborone, Botswana, 8Gaborone Private Hospital, Gaborone, Botswana, 9Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
Purpose/Objective(s): Vulvar cancer is a rare gynecological malignancy globally, but due to high rates of HIV and HPV, it is more common in Botswana. Early-stage disease is ideally managed surgically, while advanced-stage requires multimodal therapy, including radiotherapy (RT). Previous work by our group has reported a two-year survival rate of 74% for vulvar cancer patients in Botswana, influenced by clinical stage and surgical treatment. In this study, we analyzed an expanded cohort to further characterize survival and identify factors impacting patient outcomes.
Materials/Methods: A total of 199 women with vulvar pathology were enrolled in a prospective cohort study from 2016 to 2023 at Princess Marina Hospital, Botswana. Clinical and demographic data were collected during visits. Survival outcomes were analyzed using the log-rank test for univariate comparisons, and Cox proportional hazards regression for multivariate.
Results: The median age was 45 years (IQR 40-50). Most patients were single (77.4%) and lived a median of 50 km away (IQR 40-200). HIV prevalence was 89%, with a median CD4+ count of 524 cells/µL (IQR 329–742). Of 199 patients, 180 had invasive vulvar carcinoma and 19 had vulvar intraepithelial neoplasia (VIN).
Cancer staging revealed 50.6% (n=86) with early-stage (FIGO I/II) and 49.4% (n=84) with advanced-stage (FIGO III/IV) disease. Median OS for invasive vulvar cancer was 5.2 years, though survival was not correlated with HIV (p=0.3). Patients with early-stage disease had significantly better survival rates (p<0.001); 3-year OS was 91.4% (95% CI 83.4–100.0) vs. 44.4% for advanced-stage (95% CI 32.3–60.0). Surgery (n=71) was linked to increased survival (p<0.001), with 3-year OS of 92.6% (95% CI 85.9–99.9) vs. 54.2% (95% CI 43.0–68.3) without surgery. RT was delivered to 118 patients; 89 had definitive-intent RT (median dose 5900cGy, IQR 5040–6080), while 29 had palliative-intent RT (median dose 2000cGy, IQR 2000–3000). In comparison to patients that did not receive RT, patients treated with definitive-intent (p = 0.024) and palliative-intent (p<0.001) RT had significantly decreased survival. 3-year OS was 93.3% (95% CI 87.1-100.0) for those without RT, 73.3% (95% CI 61.9-86.8) for definitive-intent RT, and 10.4% (95% CI 2.8-38.3) for palliative-intent RT. Most without RT had early-stage disease (82.3%), while 85.7% receiving palliative RT had advanced-stage. On multivariate analysis, only early-stage disease (HR 0.27, 95% CI 0.111–0.65) and surgery (HR 0.20, 95% CI 0.071–0.58) were independent predictors of improved survival.Conclusion: Vulvar cancer in Botswana is mostly seen among HIV-infected women and presents at a young age. While early-stage disease and surgical intervention are strongly linked to better outcomes, many patients face barriers to timely diagnosis and treatment. Expanding early detection, improving surgical access, and optimizing RT protocols could improve survival in this high-risk population.