Groin dissection versus groin radiation in carcinoma of the vulva: A gynecologic oncology group study

Stehman, Frederick B.; Bundy, Brian N.; Thomas, Gillian; Varia, Mahesh A.; Okagaki, Takashi; Roberts, James A.; Bell, Jeffrey A.; Heller, Paul B.

doi:10.1016/0360-3016(92)90699-i

Cited by 216 publications

(68 citation statements)

References 14 publications

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“…Furthermore, in case 1, node enlargement could have also been caused by inflammation due to the prior laser excision of the tumor, followed by wound infection. Also, the results of the study of Hyde et al [16] are promising, the results of studies evaluating groin surgery versus primary radiation in vulvar cancer are inconclusive [17,18] , and definitive recommendations are still under debate.…”

Section: Discussionmentioning

confidence: 99%

Single Large Inguinal Lymph Node Metastasis in Human Papillomavirus-Induced Early Invasive Vulvar Cancer of the Anterior Fourchette in Two Young Women

Hampl

Kueppers²

2008

Gynecol Obstet Invest

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The incidence of human papillomavirus (HPV)-induced vulvar cancer in young women is increasing and often presents as microinvasive or early invasive tumors in a grade 3 vulvar intraepithelial neoplasia. So far, the risk of lymph node metastases in early invasive vulvar carcinoma (depth of invasion 1.1–2.0 mm) is reported to be less than 8%. We present 2 cases of young women with early invasive vulvar cancers (depth of invasion 1.5 and 2.0 mm) induced by HPV 16 and 42. In both cases, the cancers are located between the clitoris and urethra and are each accompanied by one groin macro-metastatic lymph node. This case report highlights the necessity for complete inguinofemoral lymphadenectomy and/or adequate radiation therapy of the groin in early invasive tumors in young women to prevent cancer recurrence in the groin. Additionally, the indication for a sentinel node procedure in these specific cases requires particular caution.

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Section: Discussionmentioning

confidence: 99%

Single Large Inguinal Lymph Node Metastasis in Human Papillomavirus-Induced Early Invasive Vulvar Cancer of the Anterior Fourchette in Two Young Women

Hampl

Kueppers²

2008

Gynecol Obstet Invest

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“…Most recurrences are diagnosed within 2 years. The median survival after recurrence in the groin is 9 months (6). Only 20-30% of the patients in early stages have positive inguinal-femoral lymph node metastases.…”

Section: Introductionmentioning

confidence: 99%

“…The acute and late morbidity are less than with lymphadenectomy (10). In 1992, Stehman et al published GOG study 88 (6). The objective of that study was to document the rates of recurrence between patients randomly assigned to either groin dissection or radiation to the intact groin.…”

Section: Introductionmentioning

confidence: 99%

Prophylactic inguinal-femoral irradiation as an alternative to primary lymphadenectomy in treatment of vulvar carcinoma

Hallak

Ladi²,

Sorbe

2007

Int J Oncol

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Abstract. In a complete geographic series of 294 cases of primary vulvar carcinomas prophylactic inguinal-femoral irradiation was used as a standard postoperative therapy. Inguinal lymph node dissection was performed in only 27 cases (9%) and was not part of the standard surgery. The histology was squamous cell carcinoma in 269 cases (92%). The primary surgery was total vulvectomy, partial vulvectomy, or local resection of the tumor. The main type of radiotherapy was adjuvant inguinal irradiation. Two separate, symmetrical and rectangular inguinal fields were irradiated with combined photon and electron beams. In the complete series 127 recurrences (43%) were recorded. Local (24%) and regional recurrences (19%) were most frequent. Type of surgery was not associated with the risk of tumor recurrence. The 5-year overall survival rate was 53% and the relapse-free survival (RFS) rate was 55%. Tumor grade was significantly (P=0.007) associated with the RFS. The inguinal RFS rate was 75% both for patients treated with adjuvant inguinal irradiation without lymphadenectomy and patients treated with primary lymphadenectomy ± inguinal irradiation. Postoperative complications were recorded in 22%. Postoperative complications occurred most frequently in the subgroup undergoing inguinal lymphadenectomy. Chronic lymph edemas were the most serious late tissue reactions.

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“…When the SLN is deemed to be truly negative, no further dissection is performed based on the low risk of non-SLN metastasis. When the SLN contains metastasis, full groin dissection is the standard of care, but alternative management with radiotherapy alone is under investigation [6]. The study by Stehman et al [6] prior to the introduction of SLN showed that lymphadenectomy followed by radiotherapy improves the outcome when there is metastasis to the groin lymph nodes.…”

Section: Introductionmentioning

confidence: 99%

“…When the SLN contains metastasis, full groin dissection is the standard of care, but alternative management with radiotherapy alone is under investigation [6]. The study by Stehman et al [6] prior to the introduction of SLN showed that lymphadenectomy followed by radiotherapy improves the outcome when there is metastasis to the groin lymph nodes. The size of SLN metastasis predicts the likelihood of non-SLN metastases [7].…”

Section: Introductionmentioning

confidence: 99%

Could Sentinel Node Mapping of the Groin Cause Extranodal Metastasis in Vulva Cancer?

Wahab

Saadeh

Lavelle

et al. 2014

Gynecol Obstet Invest

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Groin node lymphadenectomy in vulva cancer carries a substantial risk of morbid sequelae. Sentinel lymph node (SLN) mapping is a valid alternative in patients with squamous cancer of diameter <4 cm and nonsuspicious lymph nodes. SLN are mapped according to the combined technique of radioscintigraphy using technetium-labelled colloid and blue dye. We describe early extranodal recurrence in 2 patients undergoing SLN mapping. They had lymph node metastases at their original dissection. We question whether rapid lymph flow promoted by injection of colloid and dye could cause retrograde flow of cancer cells along the lymphatics draining from the pubis to the groin and extravasation of cancer cells into the dermis since these metastases arose anterior to the pubis and medial to the groin. These recurrence sites were more medial and cephalad than would be expected for skin bridge metastasis. CT imaging shows the metastases are within the dermis. No lymphatic tissue was identified around these subcuticular cancer deposits at repeat resection. Body wall extension occurs in recurrent vulva cancer, but we never saw such an early recurrence when full inguinofemoral lymphadenectomy without SLN was the standard approach. These 2 cases raise a caveat in the application of SLN mapping in vulva cancer, especially when metastasis is detected on SLN as the afferent channels to the lymph nodes may be already blocked or flow impaired by the tumour.

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Groin dissection versus groin radiation in carcinoma of the vulva: A gynecologic oncology group study

Cited by 216 publications

References 14 publications

Single Large Inguinal Lymph Node Metastasis in Human Papillomavirus-Induced Early Invasive Vulvar Cancer of the Anterior Fourchette in Two Young Women

Single Large Inguinal Lymph Node Metastasis in Human Papillomavirus-Induced Early Invasive Vulvar Cancer of the Anterior Fourchette in Two Young Women

Prophylactic inguinal-femoral irradiation as an alternative to primary lymphadenectomy in treatment of vulvar carcinoma

Could Sentinel Node Mapping of the Groin Cause Extranodal Metastasis in Vulva Cancer?

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