Incidence and predictors of toxicity in the management of vulvar squamous cell carcinoma treated with radiation therapy

McCall, Neal S.; Eng, Tony Y.; Shelton, Joseph; Hanasoge, Sheela; Patel, Pretesh; Patel, Apurva; McCook-Veal, Ashley A.; Switchenko, Jeffrey M.; Cole, Tonya E.; Khanna, Namita; Han, Chanhee H.; Gordon, Alan N.; Starbuck, Kristen; Remick, Jill

doi:10.1016/j.gore.2022.101086

Cited by 2 publications

(2 citation statements)

References 37 publications

(48 reference statements)

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“…In vulvar cancers, RT is offered as a radical treatment to non-surgical patients or in scenarios in which surgery is too morbid. Radical RT, however, has a significant side effect profile, and moderate to severe mucocutaneous reactions are frequently seen in clinical practice [4]. The role of radiation in ovarian cancers is typically palliative [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

“…It is the subject of investigation for multiple efforts in cervical and uterine cancers, as described below. Hypofractionation in vaginal cancers may follow the evidence in cervical cancer patients [3], while the expected higher acute toxicity to skin and mucosa would likely preclude its use in radical vulvar cancer treatments [4]. The uptake of hypofractionated RT in different sites is driven by different factors including improvements in technology, the search for more cost-effective treatment, a better understanding of cancer radiobiology and, more recently, the COVID-19 pandemic [21][22][23][24].…”

Section: Introductionmentioning

confidence: 99%

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Hypofractionated Radiotherapy in Gynecologic Malignancies—A Peek into the Upcoming Evidence

Amjad,

Moldovan,

Raziee

et al. 2024

Cancers

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Radiotherapy (RT) has a fundamental role in the treatment of gynecologic malignancies, including cervical and uterine cancers. Hypofractionated RT has gained popularity in many cancer sites, boosted by technological advances in treatment delivery and image verification. Hypofractionated RT uptake was intensified during the COVID-19 pandemic and has the potential to improve universal access to radiotherapy worldwide, especially in low-resource settings. This review summarizes the rationale, the current challenges and investigation efforts, together with the recent developments associated with hypofractionated RT in gynecologic malignancies. A comprehensive search was undertaken using multiple databases and ongoing trial registries. In the definitive radiotherapy setting for cervical cancers, there are several ongoing clinical trials from Canada, Mexico, Iran, the Philippines and Thailand investigating the role of a moderate hypofractionated external beam RT regimen in the low-risk locally advanced population. Likewise, there are ongoing ultra and moderate hypofractionated RT trials in the uterine cancer setting. One Canadian prospective trial of stereotactic hypofractionated adjuvant RT for uterine cancer patients suggested a good tolerance to this treatment strategy in the acute setting, with a follow-up trial currently randomizing patients between conventional fractionation and the hypofractionated dose regimen delivered in the former trial. Although not yet ready for prime-time use, hypofractionated RT could be a potential solution to several challenges that limit access to and the utilization of radiotherapy for gynecologic cancer patients worldwide.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hypofractionated Radiotherapy in Gynecologic Malignancies—A Peek into the Upcoming Evidence

Amjad,

Moldovan,

Raziee

et al. 2024

Cancers

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Neoadjuvant chemotherapy with bevacizumab for locally advanced vulvar cancer

Kuhn,

Ahmad,

Recio

et al. 2024

Int J Gynecol Cancer

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ObjectivesExternal beam radiation with sensitizing platinum is the recommended therapy for locally advanced vulvar cancers not amenable to curative surgery and is associated with considerable acute and chronic side effects. Radical vulvectomy post-radiation for persistent disease is often compromised with poor wound healing. We describe clinical outcomes for patients who received neoadjuvant chemotherapy plus bevacizumab followed by radical vulvectomy for locally advanced vulvar cancer.MethodsWe performed retrospective analyses of all patients at our institution who underwent radical vulvectomy from January 2015 to November 2023. Of 113 patients, 13 patients underwent neoadjuvant chemotherapy. Demographics and clinicopathologic data were extracted, and descriptive statistical analyses were performed. Cases with neoadjuvant chemotherapy plus bevacizumab were further evaluated for response, adverse effects, and survival.ResultsNeoadjuvant chemotherapy was administered to 13 patients with stage II-IV disease that involved the urethra, vagina, or anus. Lesion sizes ranged from 4 to 20 cm (median 7 cm). Patients received 2–6 cycles of carboplatin or cisplatin, paclitaxel, and bevacizumab. Nine (69.2%) patients had partial pathologic responses, and four patients had complete responses. All patients had negative surgical margins. Ten (76.9%) patients had radiographic evidence of inguinal lymph node metastasis prior to neoadjuvant chemotherapy, and four had residual nodal disease. Only one patient developed a superficial groin seroma. Three patients developed recurrence, two locally and one distant, and there was one death. The median follow-up was 23 months (range 6–84 months).ConclusionsNeoadjuvant chemotherapy using combination platinum/paclitaxel/bevacizumab was efficacious for locally advanced vulvar cancer, resulting in complete resections, negative margins, and excellent wound healing. A multi-institutional phase II trial is warranted to validate these findings.

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Incidence and predictors of toxicity in the management of vulvar squamous cell carcinoma treated with radiation therapy

Cited by 2 publications

References 37 publications

Hypofractionated Radiotherapy in Gynecologic Malignancies—A Peek into the Upcoming Evidence

Hypofractionated Radiotherapy in Gynecologic Malignancies—A Peek into the Upcoming Evidence

Neoadjuvant chemotherapy with bevacizumab for locally advanced vulvar cancer

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