The Radiotherapy Role in the Multidisciplinary Management of Locally Advanced Vulvar Cancer: A Multidisciplinary VulCan Team Review

Tagliaferri, Luca; Lancellotta, Valentina; Casà, Calogero; Fragomeni, Simona Maria; Ferioli, Martina; Gentileschi, Stefano; Caretto, Amelia; Corrado, Giacomo; Gui, Benedetta; Colloca, Giuseppe; Gambacorta, Maria Antonietta; Morganti, Alessio Giuseppe; Garganese, Giorgia; Macchia, G.

doi:10.3390/cancers13225747

Cited by 21 publications

(17 citation statements)

References 56 publications

(184 reference statements)

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“…In locally-advanced vulvar cancer, the standard treatment-radical surgery-is not always feasible due to the difficulty of achieving clear surgical margins without performing mutilating surgery and/or because the lymph nodes are fixed to the fascia, muscle, or vascular structures. In these cases, the treatment of choice is definitive radiotherapy with or without neoadjuvant chemotherapy [44][45][46][47][48][49][50].…”

Section: Vulvar Cancermentioning

confidence: 99%

Recommendations of the Spanish brachytherapy group of the Spanish Society of Radiation Oncology and the Spanish Society of Medical Physics for interstitial high-dose-rate brachytherapy for gynaecologic malignancies

et al. 2022

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The present document includes consensus-based recommendations from the Brachytherapy Group (GEB) of the Spanish Society of Radiation Oncology (SEOR) and the Spanish Society of Medical Physics (SEFM) for interstitial high-dose-rate (HDR) brachytherapy (BT) for gynaecologic malignancies. A nine-item survey—which included questions on experience with interstitial BT; indications and technique; applicator type; magnetic resonance imaging (MRI)-based planning; dose; fractionation schedule; and treatment planning—was sent to all radiation oncology departments (n = 174) in Spain in 2021. Responses were received from 36 centres (50% of all centres [n = 72] with a BT unit). The consensus-based recommendations presented here are based on a review of the available literature, professional experience among the group of experts, and in-person discussions held during the annual meeting of these two societies. We describe the results of the survey and the following: indications; contraindications; patient selection; description of applicators; role of imaging in planning; contouring; dose prescription; dosimetric reconstruction; optimisation; and dose indications for cancers of the cervix, vagina, and vulva. The various clinical scenarios in which interstitial BT is used in the treatment of gynaecological tumours are described in detail, including cervix intracavitary/interstitial hybrid HDR-BT; cervix perineal templates/freehand implants; primary vaginal malignancies/vaginal recurrences; and vulvar interstitial implants.

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Section: Vulvar Cancermentioning

confidence: 99%

Recommendations of the Spanish brachytherapy group of the Spanish Society of Radiation Oncology and the Spanish Society of Medical Physics for interstitial high-dose-rate brachytherapy for gynaecologic malignancies

et al. 2022

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“…Possible preventive and therapeutic interventions over fluid collection such as fibrin glue, talcum, and Picibanil (OK- 432) are performed to cause obliteration of leaking lymphatic vessels [ 33 , 34 , 35 ]. Lymphatic vessel coagulation and the presence of relevant scarring of the dead space that remains after lymphatic and adipose tissue removal, which prevents the lymph flow from re-routing, are responsible for the high incidence of secondary lymphedema, namely, up to 70% [ 36 ], with the highest risk in cases of wound infection, older age, obesity, or adjuvant radiation therapy [ 37 , 38 , 39 , 40 , 41 ].…”

Section: Discussionmentioning

confidence: 99%

Lymphatic Function of the Lower Limb after Groin Dissection for Vulvar Cancer and Reconstruction with Lymphatic SCIP Flap

Caretto

Stefanizzi

Fragomeni

et al. 2022

Cancers

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Inguinofemoral lymphadenectomy, frequently performed for vulvar cancer, is burdened with substantial immediate and long-term morbidity. One of the most disabling treatment-related sequelae is lower limb lymphedema (LLL). The present study aims to describe the wound complications and the severity of LLL in patients who have undergone groin dissection for vulvar cancer and immediate inguinal reconstruction with the Lymphatic Superficial Circumflex Iliac Perforator flap (L-SCIP). We retrospectively reviewed the data of patients who underwent bilateral groin dissection and unilateral inguinal reconstruction with the L-SCIP. The presence and severity of postoperative LLL during the follow-up period were assessed by lymphoscintigraphy and limbs’ volume measurement. In addition, immediate complications at the level of the inguinal area were registered. The changes between preoperative and postoperative limb volumes were analyzed by Student’s t test. p values < 0.05 were considered significant. Thirty-one patients were included. The mean variation of volume was 479 ± 330 cc3 in the side where groin reconstruction had been performed, and 683 ± 425 cc3 in the contralateral side, showing smaller variation in the treated side (p = 0.022). Lymphoscintigraphy confirmed the clinical findings. Based on our results, inguinal reconstruction with L-SCIP performed at the same time of groin dissection in patients treated for vulvar cancer can provide a significant protective effect on LLL.

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“…This extensive surgery includes the construction of a permanent urostoma, colostoma or both. Because of the extend of exenterative surgery, this surgery is associated with high morbidity rates and a peri-operative mortality rate of up to 2% [10,15,16]. Furthermore, patients often develop psychological problems due to major alterations in body image and loss of sexual function [8].…”

Section: Current Treatment Options For Locally Advanced Vulvar Cancer...mentioning

confidence: 99%

Neoadjuvant chemotherapy for patients with locally advanced vulvar cancer

Nooij

Schaake

Reyners

et al. 2022

Current Opinion in Oncology

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Purpose of reviewStudies on treatment options for patients with locally advanced vulvar cancer (LAVC) are scarce, and highlevel evidence for a primary treatment choice is lacking. Furthermore, current treatment options are associated with extensive morbidity and high complication rates. More effective treatment options are urgently needed. This review describes current treatment possibilities, focusing on literature regarding neoadjuvant chemotherapy (NACT) followed by surgery. Recent findingsAlthough data are heterogeneous and limited, NACT followed by surgery might be an effective and well tolerated treatment alternative associated with lower morbidity compared with current treatment options, such as excenterative surgery or definitive chemoradiation.

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The Radiotherapy Role in the Multidisciplinary Management of Locally Advanced Vulvar Cancer: A Multidisciplinary VulCan Team Review

Cited by 21 publications

References 56 publications

Recommendations of the Spanish brachytherapy group of the Spanish Society of Radiation Oncology and the Spanish Society of Medical Physics for interstitial high-dose-rate brachytherapy for gynaecologic malignancies

Recommendations of the Spanish brachytherapy group of the Spanish Society of Radiation Oncology and the Spanish Society of Medical Physics for interstitial high-dose-rate brachytherapy for gynaecologic malignancies

Lymphatic Function of the Lower Limb after Groin Dissection for Vulvar Cancer and Reconstruction with Lymphatic SCIP Flap

Neoadjuvant chemotherapy for patients with locally advanced vulvar cancer

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