Old and new perspectives in the management of high-risk, locally advanced or recurrent, and metastatic vulvar cancer

Gadducci, Angiolo; Cionini, L.; Romanini, Antonella; Fanucchi, A; Genazzani, Andrea Riccardo

doi:10.1016/j.critrevonc.2006.06.009

Cited by 104 publications

(82 citation statements)

References 158 publications

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“…It has been related to resistance to chemotherapy and poor prognosis in patients with this aggressive uterine malignancy. 29 Trastuzumab, a humanized monoclonal antibody specific for HER-2/ neu, is important in the adjuvant and metastatic treatment of patients with HER-2/neu-overexpressing breast cancer. HER-2/neu overexpression in uterine serous carcinoma provides a biological rationale for the use of trastuzumab in the treatment of this malignancy.…”

Section: Discussionmentioning

confidence: 99%

Immunophenotyping of serous carcinoma of the female genital tract

et al. 2008

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To update the data on the expression of 'mesothelioma markers' by serous carcinomas of various sites we have studied cases from ovary (n ¼ 56), endometrium (n ¼ 37), fallopian tube (n ¼ 6), primary peritoneum (n ¼ 5) and cervix (n ¼ 3) using a panel of antibodies (WT1, P53, estrogen receptors, HER2/neu, D2-40, cytokeratin 5/6 and E-cadherin). Ovarian carcinomas demonstrated D2-40 and cytokeratin 5/6 immunoreactivity in 23.2 and 55.4% of cases, respectively. Endometrial carcinomas demonstrated D2-40 and cytokeratin 5/6 immunoreactivity in 43.2 and 37.8% of cases, respectively. D2-40 staining pattern was predominantly focal; however, strong reactivity was identified in 16.2% of endometrial and 10.7% of ovarian carcinomas. HER2/neu oncoprotein overexpression was demonstrated in 7 of 37 (18.9%) uterine serous carcinomas. In contrast, all the serous carcinomas of the other sites were HER2/neu negative. The proportion of positive cases was significantly different in ovarian vs endometrial carcinomas regarding WT1 (P ¼ 0.0458), estrogen receptors (Po0.001) reactivity and HER2/neu overexpression (P ¼ 0.0025). D2-40 and cytokeratin 5/6 are expressed in a considerable proportion of serous carcinomas and should be used cautiously in a 'mesothelioma panel' in situations where serous carcinoma is in the differential diagnosis. HER2/neu was exclusively overexpressed in serous carcinomas of endometrial origin.

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Section: Discussionmentioning

confidence: 99%

Immunophenotyping of serous carcinoma of the female genital tract

et al. 2008

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“…As recent analyses have shown that already one intracapsular lymph-node metastasis leads to a significantly impaired prognosis compared with node-negative disease, it is agreed that these patients require systematic groin surgery [Gadducci et al 2006;. For this procedure, it is not sufficient to concentrate on superficial inguinal lymphadenectomy as recurrences in deep femoral lymph nodes have been observed [DiSaia et al 1979;Levenback et al 1996;Micheletti et al 1990].…”

Section: Recommendations For Groin Surgery In Intermediatestage Vulvamentioning

confidence: 99%

“…Lymph-node involvement [Pecorelli, 2009] has been proven to represent the most important prognostic factor for recurrence and survival [Gadducci et al 2006]. While 5-year disease-specific survival in patients with negative inguinofemoral lymph nodes is fairly good with a range from 70% to 93%, it significantly decreases to 25-41% in patients with lymph-node metastases [Gadducci et al 2006;Woelber et al , 2012a.…”

Section: Introductionmentioning

confidence: 99%

Management of patients with vulvar cancer: a perspective review according to tumour stage

et al. 2013

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Treatment of patients with vulvar cancer is challenging for gynaecologic oncologists. Owing to the localization in a sensitive area, surgical radicality and the indication for adjuvant treatment have to be balanced with psychosocial aspects to treat patients adequately. Clinical management is therefore highly dependent on the tumour stage. For patients with early-stage disease (FIGO I-II) therapy mainly concentrates on surgery with resection of the primary tumour and staging of the groin lymph nodes. In intermediate-stage vulvar cancer (FIGO III), advanced disease is expressed by affected inguinofemoral lymph nodes bringing radical lymphadenectomy and adjuvant therapy as well as radiation or chemoradiation into the focus of treatment. For locally advanced or metastatic vulvar cancer (FIGO IV) neoadjuvant or definitive chemoradiation has to be considered besides surgery. Owing to the low incidence of the disease, the level of evidence for different treatment modalities is poor. This review therefore puts different recommendations of clinical management in context and highlights the need for future trials.

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“…In addition to the in situ cases, microinvasive cases are also being treated with outpatient surgery in specialized units. 26 Morbidity and mortality increased with age in all cases of invasive tumors and in situ carcinomas.…”

confidence: 99%