Current controversies in the management of patients with early-stage vulvar cancer

Oonk, Maaike H. M.; Hullu, Joanne A. de; Zee, Ate G.J. van der

doi:10.1097/cco.0b013e32833c06da

Cited by 34 publications

(16 citation statements)

References 40 publications

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“…[7][8][9][10][11][12][13][14][15] The results of this study also verified that LN involvement was clearly confirmed as being the most important prognostic factor for both DFS. In the multivariate analysis, LN involvement was the independent prognostic factor regarding DFS in the current study.…”

supporting

confidence: 71%

“…19 However, the negative effect of single LN involvement on DFS was also shown by other researchers. 13,20 According to our clinical protocols, one metastatic LN was sufficient for the indication of adjuvant therapy. All patients with positive LNs were candidates for adjuvant therapy in the current study.…”

Section: International Journal Of Hematology and Oncologymentioning

confidence: 99%

“…Few authors investigated the prognostic significance of the number of removed LNs in vulvar cancer and conflicting results were reported. 10,[12][13][14][15][16] In a large population database trial of 1030 patients, Courtney-Brooks et al reported higher disease specific survival with removal of ≥ 10 LN in patients with LN negative vulvar cancer.…”

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confidence: 99%

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The Impact of Tumor and Lymph Node Characteristics on Disease Free Survival in Squamous Cell Vulvar Cancer.

Cırık¹

2016

UHOD

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We aimed to determine the prognostic significance of tumor and lymph node (LN) characteristics on disease free survival (DFS) in patients who underwent surgery for squamous cell vulvar carcinoma. A total of 94 patients who underwent vulvar surgery and groin dissection were included. The impact of clinicopathologic variables such as age, body mass index, tumor size, tumor depth, total and metastatic lymph node number on DFS were assessed. The estimates of survival were determined with Kaplan-Meier and log rank analysis. In the univariate analysis; age, body mass index, tumor size, tumor location, total LN number, metastatic LN number and adjuvant therapy did not have impact on DFS. The median number of removed LNs was 21. Although removal of higher number of lymph nodes did not improved the DFS, patients who had ≤ 3 metastatic LNs had better 2-year DFS rate compared to those with >3 metastatic LNs (71.8% vs 40.0%; p= 0.042, respectively). In the multivariate analysis, both the depth of tumor invasion and LN involvement were the independent predictors of DFS. Additionally, in stage III disease, patients receiving adjuvant therapy had significantly less locoregional recurrence compared to those who did not receive. The presence of LN metastasis and increased tumor depth (> 3 mm) are poor prognostic factors for DFS in squamous cell vulvar cancer. Although the number of lymph nodes removed was not correlated with DFS, patients who had ≤ 3 metastatic LNs had better DFS compared to those with > 3 LNs. Keywords: Vulvar cancer, lymph node, disease free survival, recurrence ÖZET Skuamöz Hücreli Vulva Kanserinde Tümör ve Lenf Nodu Özelliklerinin Hastalıksız Sağkalıma EtkisiBu çalışmada, skuamöz hücreli vulva kanseri için cerrahi yapılan hastalarda tümör ve lenf nodu (LN) özelliklerinin hastalıksız sağkalıma (DFS) etkisini incelemek amaçlandı. Vulvar cerrahi ve lenf nodu diseksiyonu yapılan toplam 94 hasta çalışmaya dahil edildi. Yaş, vücut kitle indeksi, tümör boyutu, tümör derinliği, total ve metastatik LN sayısı gibi klinikopatolojik değişkenlerin DFS'ye etkisi araştırıldı.Sağkalım analizleri ise Kaplan-Meier ve log rank analizi ile yapıldı. Univaryant analizine göre, yaş, vücut kitle indeksi, tümör boyutu ve yeri, toplam LN sayısı, metastatik LN sayısı ve adjuvan tedavi DFS üzerine etkili bulunmadı. Ortalama olarak 21 tane LN çıkarıldı. Ortalamadan fazla lenf nodu çıkarılması DFS üzerine etkili olmasa da, 3 ve daha az metastatik LN çıkarılan hastalar, 3'den fazla metastatik LN çıkarılanlardan daha iyi 2-yıllık-DFS'ye sahip bulundu (sırasıyla, %71.8 ve %40.0; p= 0.042). Multivaryant analizde, hem tümör derinliği hem de LN tutulumu DFS'nin bağımsız prediktörleri idi. Ek olarak, evre III hastalıkta, adjuvan tedavi alan hastalar almayanlara göre daha az lokal (perineal ve kasık) nüksüne sahip idi. Lenf nodu metastazı ve artmış tümör derinliği (> 3 mm), skuamöz hücreli vulva kanseri için kötü prognostic faktörlerdir. Çıkarılan LN sayısı ile 2-yıllık-DFS korele olmasa da evre III hastalarda, 3 ve daha az metastatik LN...

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supporting

confidence: 71%

Section: International Journal Of Hematology and Oncologymentioning

confidence: 99%

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The Impact of Tumor and Lymph Node Characteristics on Disease Free Survival in Squamous Cell Vulvar Cancer.

Cırık¹

2016

UHOD

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“…A substantial clinical benefit of adjuvant radiotherapy has been clearly demonstrated for patients with two or more lymph-node metastases, whereas the role of radiation in patients with a single intracapsular metastasis remains controversial [Homesley et al 1986;Oonk et al 2010]. Fons and colleagues could not demonstrate a benefit of adjuvant radiotherapy in patients with only one affected lymph node regarding overall or disease-free survival [Fons et al 2009].…”

Section: Recommendations For Radiotherapy In Intermediate-stage Vulvamentioning

confidence: 99%

Management of patients with vulvar cancer: a perspective review according to tumour stage

et al. 2013

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Treatment of patients with vulvar cancer is challenging for gynaecologic oncologists. Owing to the localization in a sensitive area, surgical radicality and the indication for adjuvant treatment have to be balanced with psychosocial aspects to treat patients adequately. Clinical management is therefore highly dependent on the tumour stage. For patients with early-stage disease (FIGO I-II) therapy mainly concentrates on surgery with resection of the primary tumour and staging of the groin lymph nodes. In intermediate-stage vulvar cancer (FIGO III), advanced disease is expressed by affected inguinofemoral lymph nodes bringing radical lymphadenectomy and adjuvant therapy as well as radiation or chemoradiation into the focus of treatment. For locally advanced or metastatic vulvar cancer (FIGO IV) neoadjuvant or definitive chemoradiation has to be considered besides surgery. Owing to the low incidence of the disease, the level of evidence for different treatment modalities is poor. This review therefore puts different recommendations of clinical management in context and highlights the need for future trials.

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“…In the literature as a risk factors predicting vulvar cancer recurrrence have been described also intracapsular lymph-node metastasis, lymphangio invasion and large primary tumours (Burger et al, 1995;Woelber et al, 2009;Oonk et al, 2010). To get clear conclusions of vulvar cancer prognostic factors, large multicentric, prospective trial with uniform treatment approache is needed.…”

mentioning

confidence: 99%

Midline Involvement as a Risk Factor for Vulvar Cancer Recurrence

Stankeviča

Macuks²,

Baidekalna³

et al. 2012

Asian Pacific Journal of Cancer Prevention

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Current controversies in the management of patients with early-stage vulvar cancer

Abstract: Sentinel node biopsy is safe in treatment of early-stage vulvar cancer. Ongoing studies are investigating the optimal additional treatment for patients with a positive sentinel node in terms of efficacy and morbidity.

Cited by 34 publications

References 40 publications

The Impact of Tumor and Lymph Node Characteristics on Disease Free Survival in Squamous Cell Vulvar Cancer.

The Impact of Tumor and Lymph Node Characteristics on Disease Free Survival in Squamous Cell Vulvar Cancer.

Management of patients with vulvar cancer: a perspective review according to tumour stage

Midline Involvement as a Risk Factor for Vulvar Cancer Recurrence

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