Neoadjuvant chemotherapy followed by radical surgery in locally advanced vulvar carcinoma: a single-institution experience

Abstract

Background: Squamous cell carcinoma of the vulva is a rare malignancy that affects elderly women. About one-third of vulvar cancers are diagnosed in an advanced stage, requiring extensive surgery. Neoadjuvant chemotherapy (NACT) has been introduced to reduce local tumor burden. In this retrospective study, we analyze the efficacy and toxicity of NACT followed by radical surgery. Methods: Patients with locally advanced vulvar cancer (LAVC) treated at our institution with neoadjuvant platinum and paclitaxel-based chemotherapy ± ifosfamide followed by surgery at our institution were retrospectively identified. Results: Fourteen patients (93%) completed NACT with tolerable toxicities (G3–G4 toxicity: 30%). Thirteen patients (87%) underwent surgery. The overall clinical response rate on vulvar disease was 66% (20% complete response, 46% partial response), confirmed by histopathologic analysis, while on inguinal lymph nodes it was 69% (23% complete response, 46% partial response). At the pathologic examination, all patients had negative surgical margins. Three out of 9 patients (33%) with lesions infiltrating the urethral meatus and 4 patients out of 7 (57%) with anal involvement did not require urethral amputation or colostomy, respectively, after NACT. No severe postoperative complications were described. Overall survival at 5 years was 60%, and median overall survival was 76 months. Conclusion: NACT followed by surgery in locally advanced vulvar cancer is well tolerated and allows surgical modulation.

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

“…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 ].…”

Pelvic Exenteration for Recurrent Vulvar Cancer: A Retrospective Study

“…For chemoradiation, the reported complete response rates are low (50% or less), the 5-year OS is limited to 30-60% [35][36][37][38][39][40], and there is no consistent protocol for the therapy. Moore et al, 1998 [41] analyzed 73 patients with primary, advanced (FIGO III/IV) vulvar cancer and neoadjuvant chemoradiation with cisplatin/5-fluorouracil; 46.5% of the patients had complete remission and 53.3% had a gross residual tumor at the time of surgery, with positive resection margins in 13%.…”

Neoadjuvant chemotherapy for patients with locally advanced vulvar cancer

“…In 2021, Marco et al [42 ▪▪ ] reported a retrospective study on 15 LAVC patients treated with NACT followed by surgery. Chemotherapy was platinum-based and consisted of a combination of paclitaxel-ifosfamide-cisplatin, paclitaxel-cisplatin or paclitaxel-carboplatin and was administered in a three-weekly schedule.…”

“…Overall response rate was 40–86%. Surgery turned out to be possible in 40–90% of the LAVC patients who received NACT [9,14,42 ▪▪ ,43 ▪▪ ,44–47].…”