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

Abstract

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.

Diagnostic performance of preoperative [18F]FDG-PET/CT for lymph node staging in vulvar cancer: a large single-centre study

“…Another strength is the systematic evaluation of pelvic LNs, an issue that is not codified in the clinical practice. Recently, in a large series of vulvar cancer patients with pelvic nodal involvement, Shinde and co-workers showed that definitive locoregional therapy was associated with prolonged overall survival [ 35 ]. In this context, it is relevant to investigate pelvic LNs by imaging and/or histologic confirmation in order to tailor the treatment plan.…”

Safety and Benefit Of Sentinel Lymph Nodes Biopsy Compared to Regional Lymph Node Dissection in Primary Vulvar Cancer Patients Without Distant Metastasis and Adjacent Organ Invasion: A Retrospective Population Study

“…The region, insurance status, year of diagnosis, age at diagnosis, race, marital status, primary site, pathological grade, tumor size, invasion depth, surgery type, radiotherapy, lymph node size, and SLNB were derived from the corresponding fields of the SEER database. And then, they were included in regressions because they were found to be prognostic factors (12)(13)(14)(15).…”

Definitive chemoradiation or radiation therapy alone for the management of vulvar cancer

“…Thus, definitive radiation or chemoradiation may be a reasonable treatment option for select patients with grade IVB vulvar cancer and pelvic lymph node involvement. Data from the National Cancer Database also suggest a benefit for radiation therapy in the loco-regional treatment of pelvic node positive vulvar cancer without distant metastatic disease 26…”