INGUINOFEMORAL RADIATION OF N0,N1 VULVAR CANCER MAY BE EQUIVALENT TO LYMPHADENECTOMY IF PROPER RADIATION TECHNIQUE IS USED

Purpose: To update a previous retrospective study that compared inguin ofemoral irradiation (N = 23) to lymphadenectomy (N = 25) for N0, N1 v ulvar carcinoma with more patients and longer follow-up. These results , unlike the recent randomized Gynecologic Oncology Group (GOG study), suggest that radiation is a viable alternative to groin dissection, a nd the differences may be explained on the basis of irradiation techni que. Methods and Materials: Based on a growing body of data supporting control of subclinical nodal disease with irradiation in vulvar cance r, the decision was made to offer patients with squamous cell carcinom a of the vulva and clinically negative groins (N0, N1), either lymphad enectomy or inguinofemoral irradiation based on clinical factors. Beca use of the acute skin reaction and possible underdosing of deep femora l nodes with electrons as used in the GOG study, opposed photon fields to 50 Gy were used. From 1983 to 1991, 48 patients underwent a radica l vulvectomy followed by either lymphadenectomy (Group I, n = 25) or i nguinofemoral irradiation (Group II, n = 23). Results: The actuarial n odal control was 100% in Group I and 91% in Group II (p = 0.14). In ad dition, there was no difference in cause specific survival at 3 years (96% and 90%, respectively, p = 0.47). The morbidity of lymphadenectom y (Group I) included: 16% lymphedema, 16% seromas, 44% infection, and 68% wound separation. In the irradiated patients (Group II), 16% devel oped lymphedema and only 9% had a significant skin reaction. Conclusio n: Based on this analysis of local control and survival with longer fo llow-up and more patients, irradiation of the NO, N1 inguinofemoral no des may be a viable alternative to lymphadenectomy for squamous cell c arcinoma of the vulva if proper radiation technique and dose are used. In addition, the acute and delayed morbidity of lymphadenectomy excee ds that of irradiation.