Dh. Moore et al., PREOPERATIVE CHEMORADIATION FOR ADVANCED VULVAR CANCER - A PHASE-II STUDY OF THE GYNECOLOGIC-ONCOLOGY-GROUP, International journal of radiation oncology, biology, physics, 42(1), 1998, pp. 79-85
Citations number
39
Categorie Soggetti
Oncology,"Radiology,Nuclear Medicine & Medical Imaging
Purpose: To determine the feasibility of using preoperative chemoradio
therapy to avert the need for more radical surgery for patients with T
-3 primary tumors, or the need for pelvic exenteration for patients wi
th T-4 primary tumors, not amenable to resection by standard radical v
ulvectomy, Methods and Materials: Seventy-three evaluable patients wit
h clinical Stage III-IV squamous cell vulvar carcinoma were enrolled i
n this prospective, multi-institutional trial. Treatment consisted of
a planned split course of concurrent cisplatin/5-fluorouracil and radi
ation therapy followed by surgical excision of the residual primary tu
mor plus bilateral inguinal-femoral lymph node dissection. Radiation t
herapy was delivered to the primary tumor volume via anterior-posterio
r-posterior-anterior (AP-PA) fields in 170-cGy fractions to a dose of
4760 cGy. Patients with inoperable groin nodes received chemoradiation
to the primary vulvar tumor, inguinal-femoral and lower pelvic lymph
nodes, Results: Seven patients did not undergo a post-treatment surgic
al procedure: deteriorating medical condition (2 patients); other medi
cal condition (1 patient); unresectable residual tumor (2 patients); p
atient refusal (2 patients). Following chemoradiotherapy, 33/71 (46.5%
) patients had no visible vulvar cancer at the time of planned surgery
and 38/71 (53.5%) had gross residual cancer at the time of operation,
Five of the latter 38 patients had positive resection margins and und
erwent: further radiation therapy to the vulva (3 patients); wide loca
l excision and vaginectomy necessitating colostomy (1 patient); no fur
ther therapy (1 patient). Using this strategy of preoperative, split-c
ourse, twice-daily radiation combined with cisplatin plus 5-fluorourac
il chemotherapy, only 2/71 (2.8%) had residual unresectable disease. I
n only three patients was it not possible to preserve urinary and/or g
astrointestinal continence, Toxicity was acceptable, with acute cutane
ous reactions to chemoradiotherapy and surgical wound complications be
ing the most common adverse effects, Conclusion: Preoperative chemorad
iotherapy in advanced squamous cell carcinoma of the vulva is feasible
, and may reduce the need for more radical surgery including primary p
elvic exenteration. (C) 1998 Elsevier Science Inc.