PROPHYLACTIC CHEMORADIATION OF INGUINOFEMORAL LYMPH-NODES IN PATIENTSWITH LOCALLY EXTENSIVE VULVAR CANCER

Objective. Primary surgical resection of locally advanced squamous can cer of the vulva may compromise the integrity of important midline str uctures such as the anus, clitoris, urethra, and vagina. Chemoradiatio n (synchronous radiation and cytotoxic chemotherapy) has been used as alternative initial treatment which may serve as definitive management for some patients, or may reduce the scope and functional sequelae of subsequent surgery in others. Inguinofemoral node dissection is assoc iated with substantial risk of both acute and late morbidity, promptin g consideration of elective inclusion of groin nodes within the irradi ated volume and deletion of subsequent groin surgery. Concern that dis ease relapse in the groins is potentially fatal suggested the prudence of formal outcome assessment of our recent experience with prophylact ic treatment of clinically uninvolved groin nodes in the context of co ncurrent chemoradiation for locally advanced primary vulvar cancer. Me thods. A review was conducted of 23 previously untreated patients with locally advanced squamous cancer of the vulva (2 T-2, 20 T-3, 1 T-4) and clinically uninvolved groin nodes (1969 FIGO stages 14 N-0, 4 N-1, and 5 N-2 with negative node biopsies) who were treated since 1987 wi th chemoradiation administered to a volume electively including bilate ral inguinofemoral nodes. These patients did not undergo subsequent gr oin surgery. Results. With follow-up from 6 to 98 months (mean, 45.3 m onths; median, 42 months), no patient has failed in the prophylactical ly irradiated inguinofemoral nodes. No patient has developed lymphedem a, vascular insufficiency, or neurological injury in a lower extremity , and no patient has experienced aseptic necrosis of a femur. Conclusi ons. Elective irradiation of the groin nodes in the context of initial chemoradiation for locally advanced vulvar cancer is an effective the rapy associated with acceptable acute toxicity and minimal late sequel ae. It constitutes a sensible alternative to groin dissection in this patient population. (C) 1997 Academic Press.