Role of tumour-free margin distance for loco-regional control in vulvar cancer—a subset analysis of the Arbeitsgemeinschaft Gynäkologische Onkologie CaRE-1 multicenter study

Woelber, Linn; Griebel, L.; Eulenburg, Christine zu; Sehouli, Jalid; Jueckstock, J; Hilpert, Felix; Gregorio, Nikolaus de; Hasenburg, Annette; Ignatov, Atanas; Hillemanns, Peter; Fuerst, Sophie; Strauß, Hans‐Georg; Baumann, Klaus; Thiel, Falk; Mustea, Alexander; Meier, W.; Harter, Philipp; Wimberger, Pauline; Hanker, Lars; Schmalfeldt, Barbara; Canzler, Ulrich; Fehm, Tanja; Luyten, Alexander; Hellriegel, Martin; Kosse, Jens; Heiss, C.; Hantschmann, Peer; Mallmann, Peter; Berno, Tamara; Pfisterer, Jacobus; Richter, Barbara; Neuser, Petra; Mahner, Sven

doi:10.1016/j.ejca.2016.09.038

Cited by 75 publications

(52 citation statements)

References 30 publications

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“…Vulvar recurrence rates were 12.6% in patients with a margin <8 mm and 10.2% in patients with a margin ≥8 mm. Consequently the need for a minimal margin of 8 mm could not be confirmed in the AGO CaRE-1 cohort 23. The question of adjuvant radiotherapy in the case of close margins has also not been answered.…”

Section: Discussionmentioning

confidence: 98%

“…Of these patients, 43%–72% will develop a second local recurrence and subsequently 57% will have a third or even more local recurrences 16. Recent German AGO CaRE-1 study data showed a lower local disease recurrence rate in node-negative VSCC of 11.8% (n=34) after median 18.3 months 23. In literature there are only six studies that investigated local recurrence rates for patients with and without vulvar LS and these studies found conflicting results 24–28.…”

Section: Discussionmentioning

confidence: 99%

“…A recent review by Te Grootenhuis et al15 reports only about two studies that investigated the risk for local recurrence for different cut-off values, and these studies did not show a difference in risk for local recurrence 14 23. One of the studies by our group Woelber et al23 analyzed 289 patients (solely treated surgically) within the AGO CaRE-1 multicenter study with primary node-negative VSCC reflecting the largest homogeneous node-negative cohort. Vulvar recurrence rates were 12.6% in patients with a margin <8 mm and 10.2% in patients with a margin ≥8 mm.…”

Section: Discussionmentioning

confidence: 99%

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Superficially invasive stage IA vulvar squamous cell carcinoma—therapy and prognosis

Grimm

Mathey

Kuerti

et al. 2019

Int J Gynecol Cancer

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ObjectivesSuperficially invasive stage IA squamous vulvar cancer (VSCC) is defined as a single lesion measuring ≤2 cm with a depth of invasion of ≤1.0 mm (FIGO stage IA). This article examines the natural course and prognosis of superficially invasive VSCC.MethodsThis is a retrospective case series of 46 patients (median age 58 years) with superficially invasive stage IA VSCC receiving wide local excision between January 1996 and November 2014 in the University Medical Center Hamburg-Eppendorf.ResultsMedian tumor size was 4 mm. In 39/46 (84.8%) patients peri-tumoral high-grade intraepithelial neoplasia (HSIL) and/or lichen sclerosus (LS) of the vulva were histologically detected: 34 (74.0%) usual type high-grade vulvar intraepithelial neoplasia (uVIN, HSIL), 4 (8.7%) LS with simultaneous VIN (3 uVIN, 1 differentiated VIN (dVIN)), 1 (2.2%) with LS only. 37/46 (80.4%) patients had a R0 resection; in 2 (4.3%) a high-grade VIN was detected in the margin and in 7 (15.2%) the resection status was unknown. The mean follow-up was 58 (range 10–185) months. Four patients (8.7%) suffered from an invasive recurrence after 4, 17, 40, and 54 months, three in the vulva and one in the groin. All local recurrences occurred in women with LS in a combination with high-grade VIN (3 uVIN, 1 dVIN). Two were treated surgically again including inguino-femoral lymphadenectomy (ifLAE) (no regional lymph node metastasis histologically) as invasion depth exceeded 1 mm. The third patient refused treatment. Inguinal recurrence was treated with a bilateral ifLAE, revealing one positive lymph node, followed by adjuvant radiotherapy (groins, pelvis). None of these patients had experienced further recurrences at last follow-up.ConclusionsSuperficially invasive VSCC is characterized by having a very good prognosis. Sole surgical therapy is highly effective. Patients with LS might benefit additionally from intensified surveillance and adequate maintenance therapy in specialized centers.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Superficially invasive stage IA vulvar squamous cell carcinoma—therapy and prognosis

Grimm

Mathey

Kuerti

et al. 2019

Int J Gynecol Cancer

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“…A recent, multicenter retrospective study, AGO-CaRE-1, observed no statistically significant impact of the clear pathological margin distance on local recurrence. 9 The safe surgical margin seems to still be on debate.…”

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confidence: 99%

The Role of Pathological Margin Distance and Prognostic Factors After Primary Surgery in Squamous Cell Carcinoma of the Vulva

Arvas

Kahramanoğlu

Beşe

et al. 2018

Int J Gynecol Cancer

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“…A meta-analysis of 10 studies showed that a tumor-free margin of < 8 mm is associated with a higher risk of local recurrence, compared with a tumor-free margin of ≥ 8 mm [12]. A subgroup analysis of 289 solely surgically treated node-negative patients with complete tumor resection enrolled in the German AGO-CaRE-1 retrospective study found that vulvar recurrence rates were 10.2% for patients with a margin of ≥ 8 mm and 12.6% for those with a closer margin; the margin distance had no significant impact on local recurrence in multivariate analysis, neither when analyzed as a continuous variable nor categorically based on the 8-mm cut-off [13]. As far as node resection is concerned, Micheletti et al [14] suggested a technique of complete deep femoral lymphadenectomy with preservation of the fascia lata and cribriform fascia, thus decreasing the intraoperative risks and reducing dead spaces with the tendency to retain secretions.…”

Section: Introductionmentioning

confidence: 99%

Adjuvant Radiotherapy in High-Risk Squamous Cell Carcinoma of the Vulva: A Two-Institutional Italian Experience

Laliscia¹,

Fabrini²,

Cafaro³

et al. 2017

Oncol Res Treat

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Background: The aim of this study was to assess the treatment benefit and patterns of recurrence for patients with high-risk vulvar squamous cell carcinoma treated with surgery followed by adjuvant radiotherapy (RT). Patients and Methods: From January 1999 to June 2016, 51 patients underwent total or partial deep vulvectomy with inguinofemoral lymphadenectomy followed by adjuvant RT with 45-50 Gy in 25 fractions +/- a 4-10 Gy boost. 17 (33.3%) women received concomitant chemotherapy. Results: Median overall survival was 81 months. The 5-year disease-free survival and overall survival rates were 52 and 63%, respectively. In univariate and multivariate analysis, patients aged ≤ 76 years and those receiving an RT total dose of > 54 Gy had a significantly lower risk of progression (p = 0.044 and 0.045; p = 0.012 and 0.018, respectively) and death (p = 0.015 and 0.011; p = 0.015 and 0.026, respectively). There was a trend towards a lower risk of progression for patients with tumor size ≤ 4 (p = 0.098) and negative lymphovascular space involvement (p = 0.080). Also, there was a trend towards a higher risk of death (p = 0.075) for grade 3 tumors. Concomitant chemotherapy provided no significant benefit. Conclusion: Only age and RT total dose are significant prognostic variables for squamous cell carcinoma of the vulva treated with primary surgery and adjuvant RT to improve local and locoregional control.

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Role of tumour-free margin distance for loco-regional control in vulvar cancer—a subset analysis of the Arbeitsgemeinschaft Gynäkologische Onkologie CaRE-1 multicenter study

Cited by 75 publications

References 30 publications

Superficially invasive stage IA vulvar squamous cell carcinoma—therapy and prognosis

Superficially invasive stage IA vulvar squamous cell carcinoma—therapy and prognosis

The Role of Pathological Margin Distance and Prognostic Factors After Primary Surgery in Squamous Cell Carcinoma of the Vulva

Adjuvant Radiotherapy in High-Risk Squamous Cell Carcinoma of the Vulva: A Two-Institutional Italian Experience

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