Patterns and frequency of recurrences of squamous cell carcinoma of the vulva

Abstract

Objective. To analyze patterns and frequency of recurrences of squamous cell carcinoma (SCC) of the vulva after wide local excision (WLE) and superficial inguinal lymphadenectomy with separate incisions and to identify prognostic factors for the development of recurrences.Methods. Between January 1985 and December 1999, all 125 consecutive patients with primary SCC of the vulva, treated with WLE and superficial inguinal lymphadenectomy, were retrospectively analyzed. Recurrences were registered by localization as: local, skin bridge, groin or distant.Results. A local recurrence was diagnosed in 29 (23%) patients, 11 (9%) developed a groin and 4 (3%) a distant recurrence. No skin bridge recurrences were identified. The 5 years local relapse-free survival was 70%. After a first local recurrence, 72% of these patients developed a second local recurrence. Adjusted for other predictors, older age (>74 years) is an independent risk factor for local recurrences (HR: 2.38; 95%-C. I.: 1.08-5.23) and stage III/IV cancer for developing groin/distant recurrences (HR: 3.03; 95%-C.I.: 1.0-9.18).Conclusion. WLE and superficial inguinal lymphadenectomy with separate incisions result in a high groin recurrence rate in this study; superficial lymphadenectomy should be replaced by deep inguinofemoral lymphadenectomy. After a local recurrence, 72% of the patients developed a second local recurrence. These patients are at high risk and need a close follow-up.

Radical interstitial HDR brachytherapy in treatment of recurrent vulvar cancer: a case study

“…According to the li- terature, a recurrent vulvar cancer after radical surgery procedures occurs in 15-40% [6-8, 22, 23] of patients and more than 50% are localized in the vulvar area [6,22]. In our patient both recurrences occurred on vulva, close to vulvectomy scar.…”

“…Failures usually occur during the first two years after initial surgical management [7,17], but in some cases they may appear even five years or more after the primary treatment [7]. Sometimes three or more local recurrences are observed [6]. Some authors suggest that late failures may be a recurrent disease but also a second primary tumour and they often occur among patients with previously diagnosed vulvar lichen sclerosus [6].…”

“…Local failures may be successfully treated with surgery or radiotherapy, while patients with groin recurrences usually die [6,10].…”

“…It accounts for 2-5% of all gynaecological carcinomas and about 0.6% of all malignant neoplasms in women [1,5,6]. Nowadays about 30% of patients who report with the advanced disease [5] are unable to undergo the standard treatment which is radical vulvectomy with inguinal lymph node dissection.…”

“…Local failures are the most frequent while and groin recurrences are less common [6]. It is estimated that even in multimodality treatment, about 10-20% of patients with FIGO I and 50-70% with the advanced disease will recur [5,[7][8][9] and 40% of them will die [5].…”