European Society of Gynaecological Oncology Guidelines for the Management of Patients With Vulvar Cancer

Oonk, Maaike H. M.; Planchamp, François; Baldwin, Peter; Bidziński, Mariusz; Brännström, Mats; Landoni, Fabio; Mahner, Sven; Mahantshetty, Umesh; Mirza, Mansoor Raza; Petersen, Cordula; Querleu, Denis; Regauer, Sigrid; Rob, Lukáš; Rouzier, Roman; Ulrikh, Elena; Velden, J. van der; Vergote, Ignace; Woelber, Linn; Zee, Ate G.J. van der

doi:10.1097/igc.0000000000000975

Cited by 159 publications

(217 citation statements)

References 3 publications

Supporting

Mentioning

209

Contrasting

Unclassified

Order By: Relevance

“…Can the HPV and p53 status of vulvar squamous carcinomas be used to guide adjuvant treatment based on the poorer prognosis of HPV-negative, p53 mutated tumors?28 30 Re-excision is preferred to adjuvant radiation therapy when surgical margins are positive or close because of short-term and long-term morbidity associated with high-dose radiation to vulvar skin. However, when anatomical structures such as the clitoris, urethra or anus limit re-excision, it is recommended that adjuvant radiation is started, preferably within 6 weeks of surgery 49. Should women with HPV-dependent or p53 mutated vulvar squamous carcinomas with positive or close margins be observed?…”

Section: Discussionmentioning

confidence: 99%

Clinical and molecular classification of vulvar squamous pre-cancers

Cohen

Anderson

Eva

et al. 2019

Int J Gynecol Cancer

View full text Add to dashboard Cite

Vulvar intraepithelial neoplasia (VIN) is a precursor to vulvar squamous cell carcinoma and is defined histopathologically by the presence of atypia. VIN has been classified into two types: usual vulvar intraepithelial neoplasia (uVIN), which is also referred to as a vulvar high-grade squamous intra-epithelial lesion (HSIL), and differentiated VIN (dVIN). The former is associated with chronic infection by sub-types of the human papilloma virus (HPV), whereas dVIN is HPV-independent and frequently associated with lichen sclerosus. The distinction is important because dVIN has a greater risk of, and more rapid transit to, vulvar squamous cell carcinoma. Furthermore, dVIN-associated vulvar cancers have an increased risk of recurrence and higher mortality than those arising from HSIL. Molecular characterization of vulvar squamous cell carcinoma precursors using next-generation sequencing is a relatively novel, but rapidly advancing field. This review appraises recent studies that have investigated the risks of progression to vulvar malignancy associated with HSIL and dVIN, the prognosis of HPV-dependent and HPV-independent vulvar squamous cell carcinomas, and conducted next generation sequencing mutation analyses to elucidate the genomic profiles underlying VIN. These studies suggest that HSIL and dVIN are characterized by different underlying molecular alterations that may have important implications for treatment and follow-up of women diagnosed with vulvar squamous cell cancer.

show abstract

Section: Discussionmentioning

confidence: 99%

Clinical and molecular classification of vulvar squamous pre-cancers

Cohen

Anderson

Eva

et al. 2019

Int J Gynecol Cancer

View full text Add to dashboard Cite

show abstract

“…Most prevalently, the patients with primary extracapsular nodal involvement presented with most frequent recurrence (90%) despite adjuvant radiotherapy. In spite of this, surgical treatment followed by radiotherapy is more efficient and preferable to radiotherapy alone [3]. In case of suspected metastatic involvement of the groin nodes, a biopsy should be performed.…”

Section: Discussionmentioning

confidence: 99%

“…Median age at vulvar cancer diagnosis is 68 years and the median age at death is 79 years [1]. Surgical treatment is a preferred treatment approach not only in the early stages but also in most locally advanced cases and recurrences [2,3]. Surgical treatment strategies for the vulva and adjacent lymph nodes has changed considerably over the past two decades.…”

Section: Introductionmentioning

confidence: 99%

“…Locally advanced findings are, from this perspective, more challenging and treatment results less satisfactory. The surgical strategy in these cases generally includes vulvectomy with systematic bilateral inguinofemoral lymphadenectomy [3,4]. In the case of extensive defects which cannot be solved by a simple suture, reconstruction surgery performed by www.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Vulvar cancer recurrence — an analysis of prognostic factors in tumour-free pathological margins patients group

et al. 2018

View full text Add to dashboard Cite

Tumour-free pathological margin of ≥ 8 mm is a major prognostic factor of local recurrence which can be influenced by the surgeon. A perfect knowledge of the extent of the disease prior to surgery supports adequately radical surgical trends. The emphasis is given on adequate radicality as well as on the reduction of overtreatment without worse-ning prognosis by simultaneously preserving the quality of life.

show abstract

“…The current guidelines for follow up after the SLN procedure in vulvar SCC are based on expert opinions rather than evidence. The Dutch guideline and The European Society of Gynaecological Oncology recommend follow up in the first 2 years, including clinical examination of the groins, but do not mention routine use of imaging of the groins . Furthermore, the Royal College of Obstetricians and Gynaecologists states that recognition of recurrence as early as possible seems logical because salvage is largely dependent on either further excision or radiotherapy.…”

Section: Introductionmentioning

confidence: 99%

The efficacy of ultrasound in the follow up after a negative sentinel lymph node in women with vulvar cancer: a prospective single‐centre study

Pouwer

Mus

IntHout³

et al. 2018

BJOG

View full text Add to dashboard Cite

ObjectiveTo determine the efficacy of the addition of an ultrasound of the groins in routine follow up of women with vulvar squamous cell carcinoma (SCC) after a negative sentinel lymph node (SLN).DesignProspective single‐centre study.SettingA tertiary expert oncology centre for the treatment of vulvar cancer.PopulationAll women with vulvar SCC with a negative SLN, treated between 2006 and 2014.MethodsWe prospectively collected data of 139 women with vulvar SCC treated with an SLN procedure. We analysed data of 76 patients with a negative SLN. Three‐monthly follow‐up visits consisted of physical examination combined with an ultrasound of the groins by a radiologist.Main outcome measuresThe diagnostic value of ultrasound in the follow up of women with vulvar SCC with a negative SLN during the first 2 years after treatment.ResultsDuring a routine visit, two asymptomatic isolated groin recurrences were detected. Both patients were treated by inguinofemoral lymphadenectomy and adjuvant radiotherapy and are alive without evidence of disease 39 and 120 months after diagnosis. In total, 348 ultrasounds and 29 fine‐needle aspiration were performed. The sensitivity of ultrasound to detect a groin metastasis was 100% (95% CI 16–100%), and specificity was 92% (95% CI 89–95%).ConclusionsRoutine follow up including ultrasound of the groin led to early detection of asymptomatic isolated groin recurrences. Further research is necessary to determine the exact role of ultrasound in the follow up of patients with vulvar SCC with a negative SLN.Tweetable abstractRoutine follow up including ultrasound of the groin led to early detection of asymptomatic isolated groin recurrences.

show abstract

European Society of Gynaecological Oncology Guidelines for the Management of Patients With Vulvar Cancer

Cited by 159 publications

References 3 publications

Clinical and molecular classification of vulvar squamous pre-cancers

Clinical and molecular classification of vulvar squamous pre-cancers

Vulvar cancer recurrence — an analysis of prognostic factors in tumour-free pathological margins patients group

The efficacy of ultrasound in the follow up after a negative sentinel lymph node in women with vulvar cancer: a prospective single‐centre study

Contact Info

Product

Resources

About