Patterns of distant metastases in vulvar cancer

Prieske, Katharina; Haeringer, N; Grimm, Donata; Trillsch, Fabian; Eulenburg, Christine zu; Burandt, Eike; Schmalfeldt, Barbara; Mahner, Sven; Mueller, Volkmar; Woelber, Linn

doi:10.1016/j.ygyno.2016.07.009

Cited by 51 publications

(54 citation statements)

References 26 publications

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“…However, the occurrence of distant metastasis from vulvar cancer is a rare event (about 5%) with very limited prognosis. [ 30 ] As regards the impact of PET/CT, Robertson et al [ 31 ] found that following FDG-PET/CT, the physician's prognostic impression changed in 29/54 (54%) and a change in patient management was documented in 30/83 (36%) of studies from patients with primary or recurrent vulvar and vaginal cancer.…”

Section: Discussionmentioning

confidence: 99%

18F-FDG PET/CT in preoperative staging of vulvar cancer patients

Crivellaro

Guglielmo

Ponti³

et al. 2017

Medicine

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The aim of this study was to assess the role of 18F-FDG PET/CT in preoperative staging of vulvar cancer patients.29 pts (69 years, range 51–88) with vulvar cancer (clinical apparent stage I-II), underwent preoperative FDG-PET/CT scan followed by radical vulvectomy and bilateral (or monolateral in case of tumor >2 cm from midline) inguinal lymphadenectomy ± sentinel node biopsy. PET/CT images were analyzed in consensus and correlated to histological findings according to a pt-based and a groin-based analyses. SUVmax of the nodal uptake of each inguinal area (if present) was calculated and correlated to histological findings. The presence of distant metastases was also considered and confirmed.PET/CT analysis in consensus resulted negative at the inguinal LN level in 17 pts (10 true negative, 7 false negative) and positive in 12 pts (7 true positive, 5 false positive). Incidence of LN metastases resulted 48%. On pt-based analysis, sensitivity, specificity, accuracy, and negative and positive predictive value of PET/CT in detecting LN metastases were 50%, 67%, 59%, 59%, and 58%, respectively. On a groin-based analysis, considering overall 50 LN-sites, sensitivity, specificity, accuracy, and negative and positive predictive value of PET/CT were 53%, 85%, 73%, 67%, and 76%, respectively. The mean value of SUVmax was 6.1 (range 0.7–16.2) for metastatic nodes, whereas 1.6 (range 0.7 – 5.4) for negative lymph-nodes (P = .007). PET/CT detected pelvic (n = 1) and both pelvic/paraortic (n = 1) nodal metastases.In clinical early stage vulvar cancer FDG PET/CT showed low sensitivity and moderate specificity for N-staging; therefore, it is not an accurate tool for the nodal status assessment. PET/CT may not be cost-effective in detecting the rare event of distant metastases, but further studies are needed.

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Section: Discussionmentioning

confidence: 99%

18F-FDG PET/CT in preoperative staging of vulvar cancer patients

Crivellaro

Guglielmo

Ponti³

et al. 2017

Medicine

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“…Approximately, a third of patients will recur (3) and undergo standard treatment with radiotherapy and platinumbased chemotherapy. Patients with distant metastases have a median survival of approximately 5 months (4). Therefore, there is an urgent need for us to increase our understanding of the molecular pathogenesis of VSCC and improve patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

Vulvar Squamous Cell Carcinoma (VSCC) as Two Diseases: HPV Status Identifies Distinct Mutational Profiles Including Oncogenic Fibroblast Growth Factor Receptor 3

Weberpals

Duciaume

et al. 2017

Clinical Cancer Research

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Patients with advanced or recurrent invasive vulvar squamous cell carcinoma (VSCC) have limited treatment options and a grave prognosis. Understanding the genomic landscape may facilitate the identification of new therapies and improve clinical outcomes. A retrospective chart review and molecular analysis of patients with VSCC from 2000 to 2016 was performed at the Ottawa Hospital Research Institute. The presence of oncogenic human papillomavirus (HPV) was determined by nested PCR and amplified DNA was sequenced using the Ion AmpliSeq Cancer Hotspot v2 Panel. The patients were divided into two groups according to HPV status (HPV-positive versus HPV-negative) and clinical outcome correlated with mutation status using descriptive statistics. In 43 VSCC patients, there was a high mutation rate in both HPV-positive (73%) and HPV-negative (90%) disease with the two subgroups expressing distinct genetic profiles. HPV-positive tumors were characterized by oncogenic mutations in (27%), (14%), and (9%), whereas HPV-negative tumors were found to have mutations in (57%), (24%), (19%), and (14%). Mutation S249C in occurred in 14% of HPV-positive tumors. While there were notable differences in the occurrence of , and mutations according to HPV status, only the rate of mutations was statistically significant ( = 0.0004). No significant difference in prognosis was found between patients with HPV-positive and HPV-negative VSCC. HPV-positive VSCC is characterized by oncogenic mutations that helps classify this subtype as a separate disease. Inhibitors of FGFR3 merit consideration as a therapeutic strategy in this neglected cancer in women..

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“…Additionally, patients with positive pelvic lymph nodes seemed to have better survival than the 2-year OS of approximately 10% reported in those with distant metastases. 13 Current management of vulvar cancer in either the definitive, neoadjuvant, or postoperative setting includes purposeful RT of lower pelvic lymph nodes, including obturator, external iliac, and internal iliac, when nodal volumes are being treated. 14 The superior aspect of the pelvic RT field, however, is slightly more nebulous and dependent on clinical scenario.…”

Section: Discussionmentioning

confidence: 99%

Role of Locoregional Treatment in Vulvar Cancer With Pelvic Lymph Node Metastases: Time to Reconsider FIGO Staging?

Shinde

Amini

et al. 2019

Journal of the National Comprehensive Cancer Network

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Background: Vulvar cancer with pelvic nodal involvement is considered metastatic (M1) disease per AJCC staging. The role of definitive therapy and its resulting impact on survival have not been defined. Patients and Methods: Patients with pelvic lymph node–positive vulvar cancer diagnosed in 2009 through 2015 were evaluated from the National Cancer Database. Patients with known distant metastatic disease were excluded. Logistic regression was used to evaluate use of surgery and radiation therapy (RT). Overall survival (OS) was evaluated with log-rank test and Cox proportional hazards modeling (multivariate analysis [MVA]). A 2-month conditional landmark analysis was performed. Results: A total of 1,304 women met the inclusion criteria. Median follow-up was 38 months for survivors. Chemotherapy, RT, and surgery were used in 54%, 74%, and 62% of patients, respectively. Surgery was associated with prolonged OS (hazard ratio [HR], 0.58; P<.001) but had multiple significant differences in baseline characteristics compared with nonsurgical patients. In patients managed nonsurgically, RT was associated with prolonged OS (HR, 0.66; P=.019) in MVA. In patients undergoing surgery, RT was associated with better OS (3-year OS, 55% vs 48%; P=.033). Factors predicting use of RT were identified. MVA revealed that RT was associated with prolonged OS (HR, 0.75; P=.004). Conclusions: In this cohort of women with vulvar cancer and positive pelvic lymph nodes, use of RT was associated with prolonged survival in those who did not undergo surgery. Surgery followed by adjuvant RT was associated with prolonged survival compared with surgery alone.

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Patterns of distant metastases in vulvar cancer

Cited by 51 publications

References 26 publications

18F-FDG PET/CT in preoperative staging of vulvar cancer patients

18F-FDG PET/CT in preoperative staging of vulvar cancer patients

Vulvar Squamous Cell Carcinoma (VSCC) as Two Diseases: HPV Status Identifies Distinct Mutational Profiles Including Oncogenic Fibroblast Growth Factor Receptor 3

Role of Locoregional Treatment in Vulvar Cancer With Pelvic Lymph Node Metastases: Time to Reconsider FIGO Staging?

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