Vulvar carcinoma and its recurrences – principles of surgical treatment

Česká verze

Authors: L. Viktora ; Luboš Minář ; Michal Felsinger ; Vít Weinberger
Authors place of work: Onkogynekologické centrum, Gynekologicko-porodnická klinika LF MU a FN Brno
Published in the journal: Ceska Gynekol 2022; 87(6): 401-407
Category: Přehledový článek s kazuistikou
doi: https://doi.org/10.48095/cccg2022401

Summary

Objective: A comprehensive overview of the surgical treatment of vulvar cancer, including recurrent forms. Methodology: A review work providing a basic overview of the pathogenesis, diagnosis and surgical treatment of vulvar cancer with a focus on the possibilities of treatment of its recurrences. It includes an illustrative case report presenting a patient with invasive squamous cell carcinoma of the vulva with iterative local recurrences and subsequent development of tumor triplicity and distant metastatic involvement. Conclusion: Surgical treatment remains the main modality of vulvar cancer therapy, even in the case of locally advanced or recurrent findings. In these cases, multidisciplinary cooperation of operational fields is necessary. The discipline of treated patients with participation in regular dispensary care plays an important role in the early detection of recurrences. (Chemo) radiotherapy remains a possible alternative to the surgical solution; in clinical practice, radiotherapy has an irreplaceable place in adjuvant therapy. Regional and distant recurrences are characterized by a poor prognosis.

Keywords:

surgery – Chemoradiotherapy – local recurrence – vulvar cancer – groin (inguinal) recurrence – distant recurrence

Zdroje

1. Dušek L, Mužík J, Kubásek M et al. Epidemiologie zhoubných nádorů v České republice. Masarykova univerzita. 2005 [online]. Dostupné z: http: //www.svod.cz.

2. Modesitt SC, Waters AB, Walton L et al. Vulvar intraepithelial neoplasia III: occult cancer and the impact of margin status on recurrence. Obstet Gynecol 1998; 92 (6): 962–966. doi: 10.1016/s0029-7844 (98) 00350-0.

3. Minar L, Felsinger M, Cihalova M et al. Vulvar cancer recurrence – an analysis of prognostic factors in tumour-free pathological margins patients group. Ginekol Pol 2018; 89 (8): 424–431. doi: 10.5603/GP.a2018.0073.

4. Oonk MH, Planchamp F, Baldwin P et al. European Society of Gynaecological Oncology guidelines for the management of patients with vulvar cancer. Int J Gynecol Cancer 2017; 27 (4): 832–837. doi: 10.1097/IGC.0000000000000 975.

5. de Hullu JA, van der Zee AG. Surgery and radiotherapy in vulvar cancer. Crit Rev Oncol Hematol 2006; 60 (1): 38–58. doi: 10.1016/ j.critrevonc.2006.02.008.

6. Covens A, Vella ET, Kennedy EB et al. Sentinel lymph node biopsy in vulvar cancer: systematic review, meta-analysis and guideline recommendations. Gynecol Oncol 2015; 137 (2): 351–361. doi: 10.1016/j.ygyno.2015.02.014.

7. Aviki EM, Esselen KM, Barcia SM et al. Does plastic surgical consultation improve the outcome of patients undergoing radical vulvectomy for squamous cell carcinoma of the vulva? Gynecol Oncol 2015; 137 (1): 60–65. doi: 10.1016/ j.ygyno.2015.02.001.

8. Reade CJ, Eiriksson LR, Mackay H. Systemic therapy in squamous cell carcinoma of the vulva: current status and future directions. Gynecol Oncol 2014; 132 (3): 780–789. doi: 10.1016/ j.ygyno.2013.11.025.

9. Graham K, Burton K. „Unresectable“ vulval cancers: is neoadjuvant chemotherapy the way forward? Curr Oncol Rep 2013; 15 (6): 573–580. doi: 10.1007/s11912-013-0349-x.

10. Ramanah R, Lesieur B, Ballester M et al. Trends in of late-stage squamous cell vulvar carcinomas: analysis of the surveillance, epidemiology, and end results (SEER) database. Int J Gynecol Cancer 2012; 22 (5): 854–859. doi: 10.1097/IGC.0b013e318249bce6.

11. Nooij LS, Brand FA, Gaarenstroom KN et al. Risk factors and treatment for recurrent vulvar squamous cell carcinoma. Crit Rev Oncol Hematol 2016; 106: 1–13. doi: 10.1016/ j.critrevonc.2016.07.007.

12. Te Grootenhuis NC, van der Zee AG, van Doorn HC et al. Sentinel nodes in vulvar cancer: long-term follow-up of the GROningen INternational Study on Sentinel nodes in Vulvar cancer (GROINSS-V) I. Gynecol Oncol 2016; 140 (1): 8–14. doi: 10.1016/j.ygyno.2015.09. 077.

13. Gadducci A, Tana R, Barsotti C et al. Clinico-pathological and biological prognostic variables in squamous cell carcinoma of the vulva. Crit Rev Oncol Hematol 2012; 83 (1): 71–83. doi: 10.1016/j.critrevonc.2011.09.003.

14. Simonsen E. Treatment of recurrent squamous cell carcinoma of the vulva. Acta Radiol Oncol 1984; 23 (5): 345–348. doi: 10.3109/02841868409136031.

15. Deka P, Barmon D, Shribastava S et al. Prognosis of vulval cancer with lymph node status and size of primary lesion: a survival study. J Midlife Health 2014; 5 (1): 10–13. doi: 10.4103/0976-7800.127784.

16. Klapdor R, Hertel H, Soergel P et al. Groin recurrences in node negative vulvar cancer patients after sole sentinel lymph node dissection. Int J Gynecol Cancer 2017; 27 (1): 166–170. doi: 10.1097/IGC.0000000000000860.

17. Fonseca-Moutinho JA. Recurrent vulvar cancer. Clin Obstet Gynecol 2005; 48 (4): 879–883. doi: 10.1097/01.grf.0000179671.989 39.fe.

18. Witteveen PO, van der Velden J, Vergote I et al. Phase II study on paclitaxel in patients with recurrent, metastatic or locally advanced vulvar cancer not amenable to surgery or radiotherapy: a study of the EORTC-GCG (European Organisation for Research and Treatment of Cancer-Gynaecological Cancer Group). Ann Oncol 2009; 20 (9): 1511–1516. doi: 10.1093/annonc/ mdp043.