Neoadjuvant chemoradiotherapy followed by surgery in locally advanced squamous cell carcinoma of the vulva

Gaudineau,A.; Weitbruch,D.; Quetin,P.; Heymann,S.; Petit,T.; Volkmar,P.; Bodin,F.; Velten,M.; Rodier,J.F.

doi:10.3892/ol.2012.831

Neoadjuvant chemoradiotherapy followed by surgery in locally advanced squamous cell carcinoma of the vulva

Authors:
- A. Gaudineau
- D. Weitbruch
- P. Quetin
- S. Heymann
- T. Petit
- P. Volkmar
- F. Bodin
- M. Velten
- J.F. Rodier
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Affiliations: Department of Surgical Oncology, Regional Paul Strauss Cancer Centre, 67065 Strasbourg, France, Department of Radiotherapy, Regional Paul Strauss Cancer Centre, 67065 Strasbourg, France, Department of Medical Oncology, Regional Paul Strauss Cancer Centre, 67065 Strasbourg, France, Department of Biostatistics, Regional Paul Strauss Cancer Centre, 67065 Strasbourg, France
Published online on: July 27, 2012 https://doi.org/10.3892/ol.2012.831
Pages: 719-722

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Abstract

Alternative therapies have been sought to alleviate mutilation and morbidity associated with surgery for vulvar neoplasms. Our prime objective was to assess tumor absence in pathological vulvar and nodal specimens following neoadjuvant chemoradiotherapy in locally advanced vulvar neoplasms. Data were retrospectively collected from January 2001 to May 2009 from 22 patients treated with neoadjuvant therapy for locally advanced squamous cell carcinoma of the vulva. Neoadjuvant treatment consisted of inguino‑pelvic radiotherapy (50 Gy) in association with chemotherapy when possible. Surgery occurred at intervals of between 5 to 8 weeks. The median age of patients at diagnosis was 74.1 years. All patients were primarily treated with radiotherapy and 15 received a concomitant chemotherapy. Additionally, all patients underwent radical vulvectomy and bilateral inguino‑femoral lymphadenectomy. Tumor absence in the vulvar and nodal pathological specimens was achieved for 6 (27%) patients, while absence in the vulvar pathological specimens was only achieved for 10 (45.4%) patients. Postoperative follow‑up revealed breakdown of groin wounds, vulvar wounds and chronic lymphedema in 3 (14.3%), 7 (31.8%) and 14 cases (63.6%), respectively. Within a median follow‑up time of 2.3 years [interquartile range (IQR), 0.6‑4.6], 12 (54.6%) patients experienced complete remission and 6 cases succumbed to metastatic evolution within a median of 2.2 years (IQR, 0.6-4.6), with 1 case also experiencing perineal recurrence. Median survival time, estimated using the Kaplan-Meier method, was 5.1 years (IQR, 1.0‑6.8). We suggest that neoadjuvant chemoradiotherapy may represent a reliable and promising strategy in locally advanced squamous cell carcinoma of the vulva.

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1.	LJ RogersB HowardL Van WijkChemoradiation in advanced vulval carcinomaInt J Gynecol Cancer19745751200910.1111/IGC.0b013e3181a1302119509582
2.	GM ThomasAJ DemboSCP BrysonR OsborneAD DePetrilloChanging concepts in the management of vulvar cancerGynecol Oncol42921199110.1016/0090-8258(91)90223-R1916517
3.	RC BoronowBT HickmanMT ReaganRA SmithRE SteadhamCombined therapy as an alternative to exenteration for locally advanced vulvovaginal cancer. II. Results, complications and dosimetric and surgical considerationsAm J Clin Oncol10171181198710.1097/00000421-198704000-000553565317
4.	NF HackerJS BerekGJF JuillardLD LagassePreoperative radiation therapy for locally advanced vulvar cancerCancer5420562061198410.1002/1097-0142(19841115)54:10%3C2056::AID-CNCR2820541003%3E3.0.CO;2-L6488136
5.	T IversenIrradiation and bleomycin in the treatment of inoperable vulval carcinomaActa Obstet Gynecol Scand6119519719826181648
6.	M ScheistroenC TropeCombined bleomycin and irradiation in preoperative treatment of advanced squamous cell carcinoma of the vulvaActa Oncol3265766119927505091
7.	W LevinG GoldbergM AltarasB BlochMG SheltonThe use of concomitant chemotherapy and radiotherapy prior to surgery in advanced stage carcinoma of the vulvaGynecol Oncol25202519863732915
8.	LS EvansCR KershWC ConstablePT TaylorConcomitant 5-fluorouracil, mitomycin-C, and radiotherapy for advanced gynecologic malignanciesInt J Radiat Oncol Biol Phys15901906198810.1016/0360-3016(88)90124-13141319
9.	SA WahlenJD SlaterRJ WagnerConcurrent radiation therapy and chemotherapy in the treatment of primary squamous cell carcinoma of the vulvaCancer752289229419957712439
10.	A AklM AklG BoikeJ HebertJ GrahamPreliminary results of chemoradiation as a primary treatment for vulvar carcinomaInt J Radiat Oncol Biol Phys48415420200010974455
11.	N MulayimD Foster SilverPE SchwartzS HigginsChemoradiation with 5-fluorouracil and mitomycin C in the treatment of vulvar squamous cell carcinomaGynecol Oncol93659666200415196861
12.	WJ KohHJ Wallace IIIBE GreerCombined radiotherapy in the management of local-regionally advanced vulvar cancerInt J Radiat Oncol Biol Phys2680981619938344850
13.	SC HanDH KimSA HigginsML CarcangiuBM KacinskiChemoradiation as primary or adjuvant treatment for locally advanced carcinoma of the vulvaInt J Radiat Oncol Biol Phys4712351244200010.1016/S0360-3016(00)00569-110889377
14.	JS BerekJM HeapsYS FuGJ JulliardNF HackerConcurrent cisplatin and 5-fluorouracil chemotherapy and radiation therapy for advanced-stage squamous carcinoma of the vulvaGynecol Oncol4219720119911955180
15.	AH RussellJB MesicSA ScudderSynchronous radiation and cytotoxic chemotherapy for locally advanced or recurrent squamous cancer of the vulvaGynecol Oncol47142019921427394
16.	MJ CunninghamRP GoyerSK GibbonsDC KredentserJH MalfetanoH KeysPrimary radiation, cisplatin, and 5-fluorouracil for advanced squamous carcinoma of the vulvaGynecol Oncol6625826119979264573
17.	G LupiF RaspagliesiR ZucaliCombined preoperative chemoradiotherapy followed by radical surgery in locally advanced vulvar carcinoma: a pilot studyCancer7714721478199610.1002/(SICI)1097-0142(19960415)77:8%3C1472::AID-CNCR8%3E3.0.CO;2-E8608531
18.	F LandoniA ManeoG ZanettaConcurrent preoperative chemotherapy with 5-fluorouracil and mitomycin C and radiotherapy (FUMIR) followed by limited surgery in locally advanced and recurrent vulvar carcinomaGynecol Oncol613213271996
19.	PJ EifelM MorrisTW BurkeC LevenbackDM GershensonProlonged continuous infusion cisplatin and 5-fluorouracil with radiation for locally advanced carcinoma of the vulvaGynecol Oncol59515619957557615
20.	K GersztenRN SelvarajJ KelleyC FaulPreoperative chemoradiation for locally advanced carcinoma of the vulvaGynecol Oncol99640644200510.1016/j.ygyno.2005.07.12616169579
21.	CP MorrowJP CurtinE Lopez de la OsaRadical total vulvectomyGynecologic Cancer SurgeryChurchill Livingstone IncNew York4144321996
22.	DH MooreGM ThomasGS MontanaA SaxerDG GallupG OltPreoperative chemoradiation for advanced vulvar cancer: a phase II study of the Gynecologic Oncology GroupInt J Radiat Oncol Biol Phys427985199810.1016/S0360-3016(98)00193-X9747823
23.	GS MontanaGM ThomasDH MoorePreoperative chemo-radiation for carcinoma of the vulva with N2/N3 nodes: a gynecologic oncology group studyInt J Radiat Oncol Biol Phys4810071013200010.1016/S0360-3016(00)00762-811072157
24.	F TomaoC Di TucciC MarchettiG PerniolaF BellatiPB PaniciRole of chemotherapy in the management of vulvar carcinomaCrit Rev Oncol Hematol822539
25.	C LhommeT PetitR LargillierF MayerA FloquetA ReyM JimenezC Haie-MederConcomitant weekly carboplatin (CB) and paclitaxel (P) with pelvic radiotherapy (RT) for the treatment of advanced cervical cancer (ACC): A FNCLCC gynecologic group phase I trialJ Clin OncolASCO abs. 55422007
26.	LC ArgentaMJ MorykwasVacuum-assisted closure: a new method for wound control and treatment: clinical experienceAnn Plast Surg38563576199710.1097/00000637-199706000-000029188971