Locally advanced vulva cancer: A single centre review of anovulvectomy and a systematic review of surgical, chemotherapy and radiotherapy alternatives. Is an international collaborative RCT destined for the “too difficult to do” box?

O’Donnell, Rachel; Verleye, Leen; Ratnavelu, Nithya; Galaal, Khadra; Fisher, A; Naik, Raj

doi:10.1016/j.ygyno.2016.12.007

Cited by 16 publications

(24 citation statements)

References 72 publications

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“…The mainstay of treatment for recurrent vulvar cancer is surgery;however, for some cases, adequate excision of the tumor with clear margins can solely be achieved by exenteration and the formation of bowel and/or urinary stoma 3. Furthermore, surgical management is often precluded amongst compromised and elderly women 4 5.…”

Section: Introductionmentioning

confidence: 99%

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Use of electrochemotherapy in women with vulvar cancer to improve quality-of-life in the palliative setting: a meta-analysis

Tranoulis

Georgiou

Founta

et al. 2019

Int J Gynecol Cancer

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IntroductionElectrochemotherapy involves the use of transient tumor permeabilization via electric pulses in combination with low-dose chemotherapeutic agents. It has recently emerged as an alternative treatment modality in vulvar cancer. The aim of this meta-analysis was to ascertain the effectiveness of electrochemotherapy in the context of palliative care.MethodsThe following databases were searched: MEDLINE, Scopus, and Cochrane Database, to identify all registered articles pertaining to palliative vulvar cancer treatment with electrochemotherapy from inception until August 2019, in line with PRISMA guidelines. A single-proportion meta-analysis was performed for the outcomes of overall response, complete response, partial response, stable disease, and progressive disease raterespectively, using the random-effect model. Sensitivity analysis was performed to address heterogeneity.ResultsFour studies were included totaling 104 women. The studies were of moderate quality. Pooled results from four studies rendered a summary proportion of 78.8% (95% CI 70.4% to 86.1%) for the outcome of overall response. The median age ranged between 68 and 85 years. The sample size per study ranged between eight and 61 women. The tumors’ histological types included: squamous-cell carcinoma (96.2%), Paget’s disease (2.9%), and malignant melanoma (0.9%). A total of 65 patients (62.5%) presented with a single nodule, whilst 39 patients (37.5%) presented with multiple nodules. Eighty-nine women (85.6%) were previously submitted to other treatment modalities. The overall response rate ranged from 73.2% to 80.9%. The pooled proportion for the outcomes of complete and partial response rate was 48.7% (95% CI 30.74% to 61.5%) and 30.2% (95% CI 21.7% to 39.4%), respectively. The follow-up ranged from 1 to 51 months. No severe adverse effects were reported. The safety profile of electrochemotherapy was favorable.ConclusionsElectrochemotherapy is an effective and minimally invasive treatment modality in the palliative care management of patients with vulvar cancer. The effective control of vulvar tumors by electrochemotherapy may contribute to improvement of quality-of-life. In light of the moderate quality of evidence, a multi-center cooperation is warranted to confirm its palliative benefit.

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Section: Introductionmentioning

confidence: 99%

“…Nonetheless, its use is often burdened with significant toxicity amongst women previously treated with radiotherapy 7. Chemotherapy can also be used in recurrent cases; notwithstanding, its role remains limited 3 8…”

Section: Introductionmentioning

confidence: 99%

Use of electrochemotherapy in women with vulvar cancer to improve quality-of-life in the palliative setting: a meta-analysis

Tranoulis

Georgiou

Founta

et al. 2019

Int J Gynecol Cancer

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“…Advanced carcinoma of the vulva is defined as cancer that commonly invades or crosses the borders of surrounding structures such as the urethra, anus, bladder, and other adjacent organs. [ 7 ] It presents initially in an inoperable form, that is, primary radical surgery does not remove the tumor with adequate margins. Therefore, primary exenterative surgery is needed in this patient population, which can lead to severe postoperative comorbidities and poorer quality of life.…”

Section: Introductionmentioning

confidence: 99%

Clinical analysis of neoadjuvant chemotherapy in patients with advanced vulvar cancer

et al. 2018

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To investigate the effect of neoadjuvant chemotherapy in patients with advanced vulvar cancer and to provide references for clinical treatment.Clinical and pathological data of 12 patients with advanced vulvar carcinoma were collected. The response and operability rates, adverse effects, and prognosis of neoadjuvant chemotherapy were retrospectively analyzed.The mean patient age was 45.8 (range 26–69) years. Among 12 patients, 9 underwent treatment with bleomycin and cisplatin with or without vincristine. The overall response rate was 67%. Five patients (56%) experienced grade 1 or 2 bone marrow suppression or gastrointestinal reactions. Seven patients (78%) underwent radical surgery. The mean overall survival time was 34.1 (range 3–69) months, the mean progression free survival time was 26 (range 3–69) months, and the 1-year survival rate was 83%. The other 3 patients received combined paclitaxel and cisplatin treatment. The overall response rate was 67%. All 3 patients (100%) experienced grade 2 hair loss or anemia and 2 of them (67%) underwent radical vulvectomy. The mean overall survival time was 11.7 (range 5–15) months, the mean progression free survival time was 7.7 (range 3–15) months and the 1-year survival rate was 100%. Time to overall survival and progression free survival were not significantly different between the 2 groups (P = .46 and P = .39).Owing to their high overall response rate and tolerable adverse effects, either bleomycin–cisplatin-based or paclitaxel-based neoadjuvant chemotherapy regimen can be considered a therapeutic option for advanced vulvar cancer.

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“…However, although this is not well reported in the literature, there is significant physical and psychological morbidity resulting from these procedures due to a permanent colostomy, urostomy or both [ 43 , 44 ]. In comparison with radical surgery, chemotherapy has been shown to be associated with poor survival and significant treatment-related toxicity [ 45 , 46 ]. RT combined with chemotherapy, followed by organ-sparing surgery has shown efficacy in preventing stoma formation, but is also associated with significant wound-healing problems and treatment-related mortality [ 24 , 26 , 27 ].…”

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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Locally advanced vulva cancer: A single centre review of anovulvectomy and a systematic review of surgical, chemotherapy and radiotherapy alternatives. Is an international collaborative RCT destined for the “too difficult to do” box?

Cited by 16 publications

References 72 publications

Use of electrochemotherapy in women with vulvar cancer to improve quality-of-life in the palliative setting: a meta-analysis

Use of electrochemotherapy in women with vulvar cancer to improve quality-of-life in the palliative setting: a meta-analysis

Clinical analysis of neoadjuvant chemotherapy in patients with advanced vulvar cancer

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

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