The giant steps in surgical downsizing toward a personalized treatment of vulvar cancer

Giannini, Andrea; D’Oria, Ottavia; Chiofalo, Benito; Bruno, Valentina; Baiocco, Ermelinda; Mancini, Emanuela; Mancari, Rosanna; Vincenzoni, Cristina; Cutillo, Giuseppe; Vizza, Enrico

doi:10.1111/jog.15103

Cited by 28 publications

(39 citation statements)

References 57 publications

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“…This was the conclusion, for example, of a U.S. study reporting a stable trend in 5-year overall and disease-specific survival from stage III–IV vulvar cancer between 1988 and 2007 [ 39 ]. An evolution towards less aggressive surgery has also been reported from Italy [ 46 ].…”

Section: Discussionmentioning

confidence: 99%

Trends in Net Survival from Vulvar Squamous Cell Carcinoma in Italy (1990–2015)

Mancini

Bucchi

Zamagni

et al. 2023

JCM

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(1) Objective: In many Western countries, survival from vulvar squamous cell carcinoma (VSCC) has been stagnating for decades or has increased insufficiently from a clinical perspective. In Italy, previous studies on cancer survival have not taken vulvar cancer into consideration or have pooled patients with vulvar and vaginal cancer. To bridge this knowledge gap, we report the trend in survival from vulvar cancer between 1990 and 2015. (2) Methods: Thirty-eight local cancer registries covering 49% of the national female population contributed the records of 6274 patients. Study endpoints included 1- and 2-year net survival (NS) calculated using the Pohar-Perme estimator and 5-year NS conditional on having survived two years (5|2-year CNS). The significance of survival trends was assessed with the Wald test on the coefficient of the period of diagnosis, entered as a continuous regressor in a Poisson regression model. (3) Results: The median patient age was stable at 76 years. One-year NS decreased from 83.9% in 1990–2001 to 81.9% in 2009–2015 and 2-year NS from 72.2% to 70.5%. Five|2-year CNS increased from 85.7% to 86.7%. These trends were not significant. In the age stratum 70–79 years, a weakly significant decrease in 2-year NS from 71.4% to 65.7% occurred. Multivariate analysis adjusting for age group at diagnosis and geographic area showed an excess risk of death at 5|2-years, of borderline significance, in 2003–2015 versus 1990–2002. (4) Conclusions: One- and 2-year NS and 5|2-year CNS showed no improvements. Current strategies for VSCC control need to be revised both in Italy and at the global level.

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Section: Discussionmentioning

confidence: 99%

Trends in Net Survival from Vulvar Squamous Cell Carcinoma in Italy (1990–2015)

Mancini

Bucchi

Zamagni

et al. 2023

JCM

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“…The aim of the treatment in vulvar cancer today is to reduce the radicality and morbidity of this surgery [ 36 ], and several procedures have changed to induce a minimally invasive surgical approach, especially by introducing SLN biopsy, nicely presented in recent works [ 37 ]. Our study is one of the largest cohort studies performed to date, including 30 patients with a total of 99 SLN identified and evaluating a promising method of SLN detection.…”

Section: Discussionmentioning

confidence: 99%

Performance of Indocyanine Green Compared to 99mTc-Nanocolloids for Sentinel Lymph Node Detection in Early Vulvar Cancer

et al. 2022

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Study objective: The aim of this study was to evaluate the performance of indocyanine green (ICG) compared to that of the gold standard 99mtechnetium (99mTc-nanocolloids) in detecting sentinel lymph nodes (SLN) in early vulvar cancer. Material and Methods: A single-center retrospective cohort study comparing SLN detection by 99mTc-nanocolloids and ICG was performed in patients presenting early vulvar cancer (T1/2), with clinically negative nodes. All SLN showing a radioactive and/or fluorescent signal were resected. The primary endpoints were the sensitivity, positive predictive value (PPV) and false negative (FN) rate of ICG in detecting SLN compared to 99mTc-nanocolloids. Results: Thirty patients were included and 99 SLN were identified in 43 groins. Compared to 99mTc-nanocolloids, ICG had a sensitivity of 80.8% (95% CI [72.6; 88.6%]), a PPV of 96.2% (95% CI [91.8; 100%]) and a FN rate of 19.1% in detecting SLN. Seventeen (17.1%) infiltrated (positive) SLN were identified out of the 99 SLN detected. Compared to 99mTc-nanocolloids, ICG showed a sensitivity of 82.3% (95% CI [73.1; 91.5%]), a PPV of 100% and a FN rate of 17.6% (3/17) in detecting infiltrated SLN. Conclusion: Despite its many advantages, ICG cannot be used as the sole tracer for the detection of SLN in early vulvar cancer and should be employed in conjunction with 99mTc-nanocolloids.

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“…16 The safety of cutting margins with smaller margins is also the subject of research. 17 Hence, in the future, clinicians should be more flexible in the use of radiotherapy and assess whether patients with VSCC of different etiological pathways need enhanced doses of VMAT or combined chemotherapy. Whether patients treated with surgery need routine postoperative adjuvant VMAT to avoid the side effects of radiotherapy while shortening the surgical margins to protect vulvar structures and functions and reduce the marginal recurrence rate.…”

Section: Dovepressmentioning

confidence: 99%

Complete Remission of Vulvar Squamous Cell Carcinoma After Volumetric Modulated Arc Therapy in Copper Smelting and Purification Workers: A Case Report

Yang

Cai

2023

CCID

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Vulvar squamous cell carcinoma (VSCC) is the most frequent vulvar neoplasia, with invasiveness and metastasis. Typically, surgery is the preferred treatment. Radiotherapy is commonly used for unresectable locally advanced tumors and for earlystage patients who are at risk of serious complications from surgery or have a severe concomitant disease that prevents them from undergoing surgery. Compared to external irradiation, three-dimensional conformal radiotherapy (3D-CRT), and intensity-modulated radiotherapy (IMRT), various studies using volumetric modulated arc therapy (VMAT) alone in early-stage VSCC have been reported rarely. In this case, the patient had a large skin lesion and no lymph node metastasis. Surgical excision would seriously affect the urinary function and vulvar shape, so radical radiotherapy was given. To ensure the radiation dose for the radical treatment effect and to avoid high-dose radiation to normal organs, the volumetric intensity-modulated radiotherapy technique was chosen. After treatment, the patient's vulvar appearance returned to normal, and the tumor achieved complete remission without further surgery or chemotherapy, with no local recurrence or associated toxic side effects. This suggests that the efficacy of VMAT alone in early-stage VSCC is accurate and worthy of clinical promotion. The patient had been engaged in copper smelting and purification for many years, and it is unusual for her to have skin lesions with such a large surface area. In conjunction with her previous history of nasal basal cell carcinoma, the mechanism of oxidative stress during metal exposure should be further clinically examined, as it may be crucial in the formation and progression of malignancies.

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The giant steps in surgical downsizing toward a personalized treatment of vulvar cancer

Cited by 28 publications

References 57 publications

Trends in Net Survival from Vulvar Squamous Cell Carcinoma in Italy (1990–2015)

Trends in Net Survival from Vulvar Squamous Cell Carcinoma in Italy (1990–2015)

Performance of Indocyanine Green Compared to 99mTc-Nanocolloids for Sentinel Lymph Node Detection in Early Vulvar Cancer

Complete Remission of Vulvar Squamous Cell Carcinoma After Volumetric Modulated Arc Therapy in Copper Smelting and Purification Workers: A Case Report

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