Preoperative radiotherapy followed by radical vulvectomy with inguinal lymphadenectomy for advanced vulvar carcinomas

Rotmensch, Jacob; Rubin, Steven J.; Sutton, Harold G.; Javaheri, Ghodratollah; Halpern, Howard J.; Schwartz, Jeffrey L.; Stewart, Michael John; Weichselbaum, Ralph R.; Herbst, Arthur L.

doi:10.1016/0090-8258(90)90169-l

Cited by 36 publications

(6 citation statements)

References 6 publications

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“…Hacker et al published similar findings in eight patients treated with preoperative RT with satisfactory shrinkage of tumour in 87.5%, [28]. However, in the series of 16 patients, 11 of which had perianal disease, treatment by RT to the vulva, inguinal and pelvic nodes, followed by radical vulvectomy and lymphadenectomy, failed in 6 (37.5%) patients, necessitating colostomy formation [29]. Despite macroscopic excision margins of 2 cm, 5/14 showed microscopic disease within 1 cm of the margin, three of which later developed local recurrence and a further 25% of patients developed central recurrence disease.…”

Section: Neoadjuvant Radiotherapy (N=5 Studies)mentioning

confidence: 74%

Locally advanced vulva cancer: A single centre review of anovulvectomy and a systematic review of surgical, chemotherapy and radiotherapy alternatives. Is an international collaborative RCT destined for the “too difficult to do” box?

O’Donnell

Verleye

Ratnavelu

et al. 2017

Gynecologic Oncology

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There remains inadequate evidence to identify an optimal treatment for LAVC. However, there is sufficient evidence to support a trial of anovulvectomy versus chemoradiation. Discussions and consensus would be needed to determine trial criteria including the primary outcome measure. Neoadjuvant chemotherapy or radiotherapy alone may be best reserved for the palliative setting or metastatic disease.

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Section: Neoadjuvant Radiotherapy (N=5 Studies)mentioning

confidence: 74%

Locally advanced vulva cancer: A single centre review of anovulvectomy and a systematic review of surgical, chemotherapy and radiotherapy alternatives. Is an international collaborative RCT destined for the “too difficult to do” box?

O’Donnell

Verleye

Ratnavelu

et al. 2017

Gynecologic Oncology

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“…Furthermore, Rotmensch et al 13 reported that 16 patients with vulvar carcinoma involving the rectum/anus, urethra, or vagina were treated with radiation to the vulva, inguinal, and pelvic nodes followed by a radical vulvectomy and inguinal lymphadenectomy. Twelve tumors regressed after radiotherapy, with 62.5% of the patients having visceral preservation.…”

Section: Discussionmentioning

confidence: 99%

Recurrence Patterns and Prognostic Factors in Chinese Patients With Squamous Cell Carcinoma of the Vulva Treated With Primary Surgery

Cheng

Zang

et al. 2009

Int J Gynecol Cancer

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The purpose of this study was to identify the prognostic factors for disease-free survival (DFS) and recurrence patterns in Chinese women with squamous cell carcinoma of the vulva treated with primary surgery. From 1980 through 2002, 100 patients with invasive squamous cell carcinoma of the vulva treated with primary surgery were included in this retrospective study. Survival analyses included the Kaplan-Meier method, log-rank test, and Cox proportional hazards model. The 5- and 10-year DFS rates were 66.5% and 45.2%, respectively. Among all the tumor-related variables age, International Federation of Gynecology and Obstetrics stage, lymphovascular space invasion, and lymph node status were found to be significant predictors of DFS for the univariate analysis. Multivariate analysis proved that age (risk ratio, 6.572; 95% confidence interval, 1.759-24.546) and lymph nodes metastasis (risk ratio, 4.178; 95% confidence interval, 1.358-12.855) were the most significant prognostic factors of DFS (P < 0.05). The overall recurrence rate was 34.0% (34/100). Among the patients with recurrences, the locations of the recurrent disease were as follows: local recurrence in 20 (58.8%), groin recurrence in 2 (5.9%), local and groin in 1 (2.9%), distant metastases in 5 (14.7%), and local recurrence and distant metastases in 5 (14.7%); data were missing for 1 (2.9%) patients. Older age and lymph nodes metastases were the independent predictors of poor prognosis for patients with invasive squamous cell carcinoma of the vulva treated with primary surgery. Local recurrence was the main recurrence pattern after primary surgery which would be improved by multidisciplinary treatment.

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“…[101] first reported that preoperative irradiation produced a local control in 86% of 37 patients with locally advanced vulvovaginal cancer, thus sparing exenteration in several cases. Other authors confirmed that the combination of preoperative irradiation and limited surgery could represent a promising therapeutic option for patients with advanced vulvar carcinoma, although response rates ranged widely among the different series [102][103][104]. Some chemotherapeutic agents, such as 5-FU, may have a radiosensitizing effect and increase tumour cell kill induced by X-rays [105].…”

Section: Postoperative Adjuvant Treatment Of High-risk Patientsmentioning

confidence: 90%

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

Gadducci

Cionini

Romanini

et al. 2006

Critical Reviews in Oncology/Hematology

104

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Preoperative radiotherapy followed by radical vulvectomy with inguinal lymphadenectomy for advanced vulvar carcinomas

Cited by 36 publications

References 6 publications

Locally advanced vulva cancer: A single centre review of anovulvectomy and a systematic review of surgical, chemotherapy and radiotherapy alternatives. Is an international collaborative RCT destined for the “too difficult to do” box?

Locally advanced vulva cancer: A single centre review of anovulvectomy and a systematic review of surgical, chemotherapy and radiotherapy alternatives. Is an international collaborative RCT destined for the “too difficult to do” box?

Recurrence Patterns and Prognostic Factors in Chinese Patients With Squamous Cell Carcinoma of the Vulva Treated With Primary Surgery

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

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