Preoperative Intensity Modulated Radiation Therapy and Chemotherapy for Locally Advanced Vulvar Carcinoma: Analysis of Pattern of Relapse

Beriwal, Sushil; Shukla, Geeta; Shinde, Ashwin; Heron, Dwight E.; Kelley, Joseph L.; Edwards, Robert P.; Sukumvanich, Paniti; Richards, Scott; Olawaiye, Alexander; Krivak, Thomas C.

doi:10.1016/j.ijrobp.2012.11.012

Cited by 68 publications

(49 citation statements)

References 17 publications

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“…Intensity modulated RT (IMRT) improves the avoidance of critical structures, while maintaining adequate tumor volume coverage (7). This benefit in the treatment of vulvar carcinoma, especially in difficult cases, has been reported previously (8–10). As in anal cancer, IMRT has rapidly become a standard option in vulvar cancer and is now used in NRG Oncology protocol (Gynecologic Oncology Group [GOG] 0279) (11).…”

Section: Introductionsupporting

confidence: 76%

Consensus Recommendations for Radiation Therapy Contouring and Treatment of Vulvar Carcinoma

Gaffney

King

Viswanathan

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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Purpose The purpose of this study was to develop a radiation therapy (RT) contouring atlas and recommendations for women with postoperative and locally advanced vulvar carcinoma. Methods and Materials An international committee of 35 expert gynecologic radiation oncologists completed a survey of the treatment of vulvar carcinoma. An initial set of recommendations for contouring was discussed and generated by consensus. Two cases, 1 locally advanced and 1 postoperative, were contoured by 14 physicians. Contours were compared and analyzed using an expectation-maximization algorithm for simultaneous truth and performance level estimation (STAPLE), and a 95% confidence interval contour was developed. The level of agreement among contours was assessed using a kappa statistic. STAPLE contours underwent full committee editing to generate the final atlas consensus contours. Results Analysis of the 14 contours showed substantial agreement, with kappa statistics of 0.69 and 0.64 for cases 1 and 2, respectively. There was high specificity for both cases (≥99%) and only moderate sensitivity of 71.3% and 64.9% for cases 1 and 2, respectively. Expert review and discussion generated consensus recommendations for contouring target volumes and treatment for postoperative and locally advanced vulvar cancer. Conclusions These consensus recommendations for contouring and treatment of vulvar cancer identified areas of complexity and controversy. Given the lack of clinical research evidence in vulvar cancer radiation therapy, the committee advocates a conservative and consistent approach using standardized recommendations.

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Section: Introductionsupporting

confidence: 76%

Consensus Recommendations for Radiation Therapy Contouring and Treatment of Vulvar Carcinoma

Gaffney

King

Viswanathan

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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“…No patient developed grade 3 or greater toxicity. 31 These data, however, would have to be confirmed in future studies on a larger scale.…”

Section: Intensity Modulated Radiation Therapymentioning

confidence: 93%

Treatment of Inoperable Vulvar Cancer

Martínez-Castro

Poveda²,

Guinot³

et al. 2016

International Journal of Gynecological Cancer

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Vulvar cancer is a rare disease affecting elderly women that is commonly treated with surgery, radiation, and chemotherapy. When tumors compromise the urethra and the anus, or when it is in the groin lymph nodes, radiotherapy, chemotherapy, or both are necessary after surgery.The treatment of locally advanced vulvar cancer has suffered significant changes though the recent decades. So far, the best sequence of treatment is not known: surgery, chemotherapy, or radiotherapy. The radical surgeries usually need a long recovery term both in the region of the vulva and in the area of the groin lymph nodes. When it is performed, convalescence can delay other treatments, such as radiotherapy and chemotherapy. On the other hand, the use of radiotherapy and chemotherapy as a first step treatment can result in a complete elimination of the disease in at least 30% of the cases or substantial reduction of its size, allowing less extensive surgery. Therefore, the historical evolution of locally advanced vulvar cancer is reviewed.

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“…20,24,25 When considering singlemodality treatment options, there is some evidence to suggest a lower risk of lymphedema after NCRT compared to ILND. A Gynecologic Oncology Group trial randomized vulvar cancer patients to groin dissection or groin radiation and showed 28% of patients undergoing ILND developed lymphedema compared to none in the radiation group.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Groin Treatment Modality and Sequence on Clinically Significant Chronic Lymphedema in Patients With Vulvar Carcinoma

Berger

Scott²,

Sukumvanich

et al. 2015

Int J Gynecol Cancer

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Preoperative Intensity Modulated Radiation Therapy and Chemotherapy for Locally Advanced Vulvar Carcinoma: Analysis of Pattern of Relapse

Cited by 68 publications

References 17 publications

Consensus Recommendations for Radiation Therapy Contouring and Treatment of Vulvar Carcinoma

Consensus Recommendations for Radiation Therapy Contouring and Treatment of Vulvar Carcinoma

Treatment of Inoperable Vulvar Cancer

The Effect of Groin Treatment Modality and Sequence on Clinically Significant Chronic Lymphedema in Patients With Vulvar Carcinoma

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