The role of brachytherapy (interventional radiotherapy) for primary and/or recurrent vulvar cancer: a Gemelli Vul.Can multidisciplinary team systematic review

Lancellotta, Valentina; Macchia, G.; Garganese, Giorgia; Fionda, Bruno; Fragomeni, Simona Maria; D’Aviero, Andrea; Casà, Calogero; Gui, Benedetta; Gentileschi, Stefano; Corrado, Giacomo; Inzani, Frediano; Rovirosa, Á.; Morganti, Alessio Giuseppe; Gambacorta, M.A.; Tagliaferri, Luca

doi:10.1007/s12094-021-02557-1

Cited by 14 publications

(16 citation statements)

References 41 publications

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“…As regards the management of locally advanced stages, surgical treatment still remains the pivotal option [ 14 ], despite often requiring large tissue resections, plastic reconstruction, and careful management of severe morbidity [ 15 , 16 , 17 ]. However, some new developments have been introduced as effective possible alternative strategies currently available, including radiation or chemo-radiation, but these suffer from the main limitation of non-repeatability over time, in case of recurrence [ 18 , 19 , 20 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

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The Vulvar Immunohistochemical Panel (VIP) Project: Molecular Profiles of Vulvar Squamous Cell Carcinoma

Garganese

Inzani

Fragomeni

et al. 2021

Cancers

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Introduction: The study’s aim was to investigate the immunohistochemical (IHC) expression of biological markers as potential prognostic/therapeutic factors in vulvar squamous cell carcinoma (VSCC). Methodology: A series of 101 patients surgically treated at our center from 2016 to 2020 were retrospectively enrolled: 53 node-negative (Group A) and 48 node-positive (Group B). A total of 146 samples, 101 from primary tumor (T) and 45 from nodal metastases (N), were investigated. The IHC panel included: p16, p53, MLH1, MSH2, MSH6, PMS2, PD-L1, CD3, HER2/neu, ER, PR, EGFR, VEGF, and CD31. The reactions were evaluated on qualitative and semi-quantitative scales. Generalized Linear Model (GLM) and cluster analysis were performed in R statistical environment. A distance plot compared the IHC panel of T with the correspondent N. Results: In Group A: p16-positive expression (surrogate of HPV-dependent pathway) was significantly higher (20.8% vs. 6.2%, p = 0.04). In Group B: PD-L1 positivity and high EGFR expression were found, respectively, in 77.1% and 97.9% patients (T and/or N). Overall, p16-negative tumors showed a higher PD-L1 expression (60.9% vs. 50.0%). In both groups: tumoral immune infiltration (CD3 expression) was mainly moderate/intense (80% vs. 95%); VEGF showed strong/moderate-diffuse expression in 13.9% of T samples; CD31, related to tumoral microvessel density (MVD), showed no difference between groups; a mutated p53 and over-expressed PD-L1 showed significant association with nodal metastasis, with Odds Ratios (OR) of 4.26 (CI 95% = 1.14–15.87, p = 0.03) and 2.68 (CI 95% = 1.0–7.19, p < 0.05), respectively; since all mismatch repair proteins (MMR) showed a retained expression and ER, PR, and HER2/neu were negative, they were excluded from further analysis. The cluster analysis identified three and four sub-groups of molecular profiles, respectively, in Group A and B, with no difference in prognosis. The molecular signature of each N and corresponding T diverged significantly in 18/41 (43.9%) cases. Conclusions: Our results support a potential role of immune checkpoint inhibitors and anti-VEGF and anti-EGFR drugs especially in patients with worse prognosis (metastatic, HPV-independent). A panel including EGFR, VEGF, PDL1, p16, and p53 might be performed routinely in primary tumor and repeated in case of lymph node metastases to identify changes in marker expression.

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Section: Introductionmentioning

confidence: 99%

“…No significant improvement has been realized in cases of poor response, progression, or distant metastasis. In these cases, few additional options are suitable, including local interventional treatments, systemic chemotherapy, or palliative care, and these unfortunately often show limited results [ 19 , 22 , 23 , 24 , 25 ].…”

Section: Introductionmentioning

confidence: 99%

The Vulvar Immunohistochemical Panel (VIP) Project: Molecular Profiles of Vulvar Squamous Cell Carcinoma

Garganese

Inzani

Fragomeni

et al. 2021

Cancers

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“…IRT could theoretically also be used as a boost after concurrent radio-chemotherapy to improve LC rates, especially in larger VCs. However, the role and real efficacy of IRT-based boost is largely unproven, with no prospective or randomized controlled trials available in this setting [ 54 ].…”

Section: Discussionmentioning

confidence: 99%

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

Tagliaferri

Lancellotta

Casà

et al. 2021

Cancers

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Locally advanced vulvar cancer (LAVC) is a challenging disease, requiring multidisciplinary management. The aim of this review is to propose an integrated clinical approach including radiotherapy (RT) in the multidisciplinary management of LAVC to customize the treatment. A review of the literature was conducted on PubMed, Scopus, and Cochrane library to acquire all relevant studies on RT in LAVC. Based on the available evidence, RT, with or without concurrent chemotherapy, has a relevant role as adjuvant and exclusive treatment or in the neoadjuvant setting. However, multicentric prospective trials are needed to define the best treatment options based on tumor and patient characteristics. A multidisciplinary and multidimensional assessment can also be useful to identify the most suitable approach, considering patients’ age and comorbidities, in view of a better treatment personalization.

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“…The treatment of vulvar cancer should be personalized, including tailored primary tumor resection and lymph nodes evaluation and/or primary chemoradiation therapy or exclusive chemo-radiation based on an individual patient's characteristics [1]. In this setting, patients with vulvar cancer should be referred to a dedicated cancer center as diagnosis and management should be multidisciplinary with a dedicated team, including a gynecologist, radiation oncologist, radiologist, nuclear medicine physician, medical oncologist, pathologist, and plastic surgeon [22][23][24][25].…”

Section: IIImentioning

confidence: 99%

MRI Staging in Locally Advanced Vulvar Cancer: From Anatomy to Clinico-Radiological Findings. A Multidisciplinary VulCan Team Point of View

Gui

Persiani

Miccò

et al. 2021

JPM

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MR imaging provides excellent spatial and contrast resolution to stage locally advanced vulvar cancer (LAVC) for tumor and nodal evaluation in order to facilitate the planning of treatment. Although there are no standard indications for how to estimate the clinical stage of International Federation of Gynecology and Obstetrics at diagnosis, MR imaging can depict the tumor and its extension to the vulvar region and adjacent organs, such as the vagina, urethra, and anus. Optimizing the MR imaging protocol and technique is fundamental for correct staging. The aim of this overview was to focus on the role of MR imaging in LAVC staging. We define vulvar anatomy and corresponding MR imaging findings, MR imaging protocol, and technique. Moreover, we describe the MR imaging findings of LAVC with example cases stage by stage. Key imaging findings based on signal intensity, diffusion restriction, and enhancement are portrayed to correctly identify and stage vulvar cancer. A structured report for LAVC staging is reported in order to give all necessary information to the clinicians and to facilitate MR imaging comprehension.

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The role of brachytherapy (interventional radiotherapy) for primary and/or recurrent vulvar cancer: a Gemelli Vul.Can multidisciplinary team systematic review

Cited by 14 publications

References 41 publications

The Vulvar Immunohistochemical Panel (VIP) Project: Molecular Profiles of Vulvar Squamous Cell Carcinoma

The Vulvar Immunohistochemical Panel (VIP) Project: Molecular Profiles of Vulvar Squamous Cell Carcinoma

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

MRI Staging in Locally Advanced Vulvar Cancer: From Anatomy to Clinico-Radiological Findings. A Multidisciplinary VulCan Team Point of View

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