Radiotherapy Versus Inguinofemoral Lymphadenectomy as Treatment for Vulvar Cancer Patients With Micrometastases in the Sentinel Node: Results of GROINSS-V II

Oonk, Maaike H. M.; Slomovitz, Brian M.; Baldwin, Peter; Doorn, Helena C. van; Velden, J. van der; Hullu, Joanne A. de; Gaarenstroom, Katja N.; Slangen, Brigitte; Vergote, Ignace; Brännström, Mats; Dorst, E.B.L. van; Driel, Willemien J. van; Hermans, R; Nunns, David; Widschwendter, Martin; Nugent, David; Holland, Cathrine; Sharma, Aarti; DiSilvestro, Paul; Mannel, Robert S.; Boll, Dorry; Cibula, David; Covens, Al; Provencher, Diane; Runnebaum, Ingo B.; Luesley, David; Ellis, Patricia; Duncan, Timothy J.; Tjiong, Ming Y.; Cruickshank, D.J.; Kjølhede, Preben; Levenback, Charles; Bouda, J; Kieser, Katharina; Palle, Connie; Spirtos, Nicola M.; O’Malley, David M.; Leitao, Mario M.; Geller, Melissa A.; Dhar, Kakali; Asher, Viren; Tamussino, Karl; Tobias, Daniel H.; Borgfeldt, Christer; Lea, Jayanthi; Bailey, Jo; Lood, Margareta; Eyjólfsdóttir, Brynhildur; Attard-Montalto, Stephen; Tewari, Krishnansu S.; Manchanda, Ranjit; Jensen, Pernille Tine; Persson, Pär; Le, Linda Van; Putter, Hein; Bock, Geertruida H. de; Monk, Bradley J.; Creutzberg, Carien L.; Zee, Ate G.J. van der

doi:10.1200/jco.21.00006

Cited by 81 publications

(84 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Six isolated groin recurrences occurred (3.8% at 2 years). The 18 patients who did not receive any further treatment had a significantly higher ipsilateral isolated groin recurrence rate than those who were treated with radiotherapy according to protocol (2 year 11.8% vs 1.6%, p=0.006) 42. Overall, GROINSS-V II showed that inguinofemoral radiotherapy with 50 Gy is a safe alternative to inguinofemoral lymphadenectomy in patients with sentinel node metastasis ≤2 mm, but not for patients with sentinel node metastasis >2 mm 42.…”

Section: Risk Factors For Nodal Recurrence and Radiotherapy Indicationsmentioning

confidence: 91%

“…For nodal bed, the suggested dose is 50–55 Gy if pathologically node positive with no extranodal extension or gross residual disease, 54–64 Gy if extranodal extension, and 60–67 Gy for gross residual nodal disease 47. Beyond investigating the addition of concurrent chemotherapy, the ongoing GROINSS-V III study is also evaluating the role of increasing the total dose in the involved groin from 50 to 56 Gy by applying a boost 42…”

Section: Radiotherapy Planning and Techniquesmentioning

confidence: 99%

Section: Treatment-related Morbiditymentioning

confidence: 99%

“…The risk of lymphedema from inguinofemoral lymphadenectomy, with or without radiotherapy, is up to ~25–30% based on previous randomized trials, GROINSS-V I and II, and large retrospective series 33 42. The risk of lymphedema with sentinel lymph node biopsy ±radiotherapy is lower 33 42. Additional important complications include gastrointestinal disease, genitourinary complications, skin atrophy, shortening and narrowing of the vagina, vaginal dryness, risk of femoral neck fracture, and for pre-menopausal women, radiotherapy-induced menopause.…”

Section: Treatment-related Morbiditymentioning

confidence: 99%

See 3 more Smart Citations

Postoperative management of vulvar cancer

Lukovic

Han

2022

Int J Gynecol Cancer

View full text Add to dashboard Cite

The primary treatment for resectable vulvar cancer includes wide local excision of the primary tumor and surgical lymph node assessment. Following surgery, up to 40–50% of patients develop a local recurrence. Historically, the strongest predictor of local recurrence is a positive or close margin (defined as <8 mm), although recent studies question the importance of margin status. Post-operative radiotherapy to the vulva is recommended for all women with a positive margin where re-excision is not possible. Radiotherapy may also be considered in the setting of risk factors for local recurrence: close margin, lymphovascular invasion, large tumor size, and/or depth of invasion >5 mm. Nodal assessment is an important component of vulvar cancer management. A negative sentinel node is associated with a low false-negative predictive value (2% in patients with vulvar tumor <4 cm in GOG 173), 2-year groin recurrence rate of 2.3%, and 3-year disease-specific survival rate of 97% in patients with unifocal vulvar tumor <4 cm in the GROningen INternational Study on Sentinel nodes in Vulvar Cancer (GROINSS-V I) study. Thus, patients with tumor size <4 cm (without additional local risk factors) and negative sentinel node can be observed. Patients with sentinel node metastasis ≤2 mm can be treated with post-operative radiotherapy (2-year isolated groin recurrence rate of 1.6% in GROINSS-V II), as a safe alternative to lymphadenectomy. Patients with sentinel node metastasis >2 mm following sentinel node biopsy should undergo inguinofemoral lymphadenectomy followed by post-operative radiotherapy—based on the GROINSS-V II study, the 2-year isolated groin recurrence rate remains unacceptably high (22%) with radiotherapy alone. Retrospective studies suggest that the addition of concurrent chemotherapy to radiotherapy may improve survival. The ongoing GROINSS-V III study is investigating concurrent chemotherapy and radiotherapy dose escalation. The main goal of these post-operative treatments is to reduce the risk of local, and especially groin, recurrences, which are almost universally fatal.

show abstract

Section: Risk Factors For Nodal Recurrence and Radiotherapy Indicationsmentioning

confidence: 91%

Section: Radiotherapy Planning and Techniquesmentioning

confidence: 99%

Section: Treatment-related Morbiditymentioning

confidence: 99%

Section: Treatment-related Morbiditymentioning

confidence: 99%

See 2 more Smart Citations

Postoperative management of vulvar cancer

Lukovic

Han

2022

Int J Gynecol Cancer

View full text Add to dashboard Cite

show abstract

“…These findings have led to the practice of omitting regional lymph node dissection in vulvar cancer when SLNs are negative. Recently, the GROINSS-V II prospective cohort study evaluated whether the use of inguinofemoral radiotherapy (50 Gy) could replace complete inguinofemoral lymph node dissection in patients with vulvar cancer (<4 cm) who have a positive SLN [ 18 ]. Due to a high rate of groin recurrence in patients with macrometastases (>2 mm), the protocol was amended to include complete inguinofemoral lymph node dissection in those with macrometastases only.…”

Section: Introductionmentioning

confidence: 99%

Sentinel Lymph Node Mapping in High-Grade Endometrial Cancer

et al. 2022

View full text Add to dashboard Cite

Sentinel lymph node (SLN) mapping is becoming an acceptable alternative to full lymphadenectomy for evaluating lymphatic spread in clinical stage I endometrial cancer (EC). While the assessment of pelvic and para-aortic lymph nodes is part of the surgical staging of EC, there is a long-standing debate over the therapeutic value of full lymphadenectomy in this setting. Although lymphadenectomy offers critical information on lymphatic spread and prognosis, most patients will not derive oncologic benefit from this procedure as the majority of patients do not have lymph node involvement. SLN mapping offers prognostic information while simultaneously avoiding the morbidity associated with an extensive and often unnecessary lymphadenectomy. A key factor in the decision making when planning for EC surgery is the histologic subtype. Since the risk of lymphatic spread is less than 5% in low-grade EC, these patients might not benefit from lymph node assessment. Nonetheless, in high-grade EC, the risk for lymph node metastases is much higher (20–30%); therefore, it is crucial to determine the spread of disease both for determining prognosis and for tailoring the appropriate adjuvant treatment. Studies on the accuracy of SLN mapping in high-grade EC have shown a detection rate of over 90%. The available evidence supports adopting the SLN approach as an accurate method for surgical staging. However, there is a paucity of prospective data on the long-term oncologic outcome for patients undergoing SLN mapping in high-grade EC, and more trials are warranted to answer this question.

show abstract

Research progress of indocyanine green fluorescence technology in gynecological applications

Li,

Zhang,

Fang

et al. 2023

Intl J Gynecology & Obste

View full text Add to dashboard Cite

Indocyanine green is a near‐infrared fluorescent dye which is widely used in various fields of surgery and gynecology. It is currently mainly used to detect various malignant tumors, sentinel lymph nodes, endometriosis lesions, ureter or intestinal occlusion, vaginal perfusion, uterine arterial blood perfusion, pelvic nerve, uterine niche, lymphatic edema, metastatic lesion shadow, and so on, providing new methods for decision‐making during surgery. This article elaborates the application progress of indocyanine green fluorescence technology in gynecology.

show abstract

Radiotherapy Versus Inguinofemoral Lymphadenectomy as Treatment for Vulvar Cancer Patients With Micrometastases in the Sentinel Node: Results of GROINSS-V II

Cited by 81 publications

References 11 publications

Postoperative management of vulvar cancer

Postoperative management of vulvar cancer

Sentinel Lymph Node Mapping in High-Grade Endometrial Cancer

Research progress of indocyanine green fluorescence technology in gynecological applications

Contact Info

Product

Resources

About