Invasive Squamous Cell Carcinoma of the Vulva: Behaviour and Results in the Light of Changing Management Regimens
Identifieur interne : 003556 ( Istex/Corpus ); précédent : 003555; suivant : 003557Invasive Squamous Cell Carcinoma of the Vulva: Behaviour and Results in the Light of Changing Management Regimens
Auteurs : D. Lingard ; K. Free ; R. G. Wright ; D. BattistuttaSource :
- Australian and New Zealand Journal of Obstetrics and Gynaecology [ 0004-8666 ] ; 1992-05.
Abstract
EDITORIAL COMMENT: We accepted this paper for publication because detailed analysis of results in 90 cases of invasive carcinoma of the vulva treated by one team of surgeons in a 10‐year period provides important information for those who must decide how to treat women with these lesions. The legends to Figure IA and B present an anecdotal case illustrating that even aged women with invasive cancer merit consideration of radical surgery.
Url:
DOI: 10.1111/j.1479-828X.1992.tb01926.x
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Lingard</name><affiliation><mods:affiliation>Departments of Gynaecologic Oncology, Brisbane</mods:affiliation></affiliation></author><author><name sortKey="Free, K" sort="Free, K" uniqKey="Free K" first="K." last="Free">K. Free</name><affiliation><mods:affiliation>Departments of Gynaecologic Oncology, Brisbane</mods:affiliation></affiliation></author><author><name sortKey="Wright, R G" sort="Wright, R G" uniqKey="Wright R" first="R. G." last="Wright">R. G. Wright</name><affiliation><mods:affiliation>Departments of Pathology, Royal Brisbane Hospital, Brisbane</mods:affiliation></affiliation></author><author><name sortKey="Battistutta, D" sort="Battistutta, D" uniqKey="Battistutta D" first="D." last="Battistutta">D. 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<hi rend="bold">EDITORIAL COMMENT</hi>: We accepted this paper for publication because detailed analysis of results in 90 cases of invasive carcinoma of the vulva treated by one team of surgeons in a 10‐year period provides important information for those who must decide how to treat women with these lesions. The legends to Figure IA and B present an anecdotal case illustrating that even aged women with invasive cancer merit consideration of radical surgery.</p><p><hi rend="bold">Summary: </hi> Ninety‐nine patients with carcinoma of the vulva were referred to the Gynaecologic Oncology Unit, Royal Brisbane Hospital, over 10 years. Ninety of these patients had a squamous cell carcinoma (SCC). They were assessed by the 1969 FIGO clinical staging. Each stage was related to nodal involvement, size, depth, histological grade, lymphvascular space involvement, perineural permeation and multifocal disease site. The operability rate was 85%. Treatment was individualized in line with recent philosophies for more conservative surgery where appropriate. Mortality was 2.6%. Five‐year survival of surgically treated patients was 60.3%; node negative patients 100%, and node positive patients 25.2%. After adjustment for stage and size, the only other independent statistically significant feature was perineural penetration. Local recurrence was more likely with increased stage and size, unclear margins and multifocal involvement. It is important to note that medically unfit patients who had vulvectomy alone and who later developed positive nodes had 100% mortality. This group of patients significantly decreases survival rates, confirming the importance of carrying out inguinofemoral lymphadenectomy at the time of initial surgery. Morbidity was decreased by conservative surgery. Lymphoedema remains the most common chronic complication. No significant difference was shown in local recurrence between different types of surgery, wide excision, hemivulvectomy, simple vulvectomy or radical vulvectomy (22%), confirming the safety of the more conservative approach of recent years.</p></abstract><textClass><classCode scheme="tocHeading1">Occasional Review including results in a series of 90 cases</classCode></textClass><langUsage><language ident="EN"></language></langUsage></profileDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/72829199C9B45ADB71F2F49A20D8B37990E4982C/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Blackwell Publishing Ltd</publisherName><publisherLoc>Oxford, UK</publisherLoc></publisherInfo><doi origin="wiley" registered="yes">10.1111/(ISSN)1479-828X</doi><issn type="print">0004-8666</issn><issn type="electronic">1479-828X</issn><idGroup><id type="product" value="AJO"></id><id type="publisherDivision" value="ST"></id></idGroup><titleGroup><title type="main" sort="AUSTRALIAN NEW ZEALJOURNAL OBSTETRICS GYNAECOLOGY">Australian and New Zealand Journal of Obstetrics and Gynaecology</title></titleGroup></publicationMeta><publicationMeta level="part" position="05002"><doi origin="wiley">10.1111/ajo.1992.32.issue-2</doi><numberingGroup><numbering type="journalVolume" number="32">32</numbering><numbering type="journalIssue" number="2">2</numbering></numberingGroup><coverDate startDate="1992-05">May 1992</coverDate></publicationMeta><publicationMeta level="unit" type="reviewArticle" position="0013700" status="forIssue"><doi origin="wiley">10.1111/j.1479-828X.1992.tb01926.x</doi><idGroup><id type="unit" value="AJO137"></id></idGroup><countGroup><count type="pageTotal" number="9"></count></countGroup><titleGroup><title type="tocHeading1">Occasional Review including results in a series of 90 cases</title></titleGroup><eventGroup><event type="firstOnline" date="2008-02-13"></event><event type="publishedOnlineFinalForm" date="2008-02-13"></event><event type="xmlConverted" agent="Converter:BPG_TO_WML3G version:2.3.6 mode:FullText source:HeaderRef result:HeaderRef" date="2010-04-20"></event><event type="xmlConverted" agent="Converter:WILEY_ML3G_TO_WILEY_ML3GV2 version:3.8.8" date="2014-01-01"></event><event type="xmlConverted" agent="Converter:WML3G_To_WML3G version:4.1.7 mode:FullText,remove_FC" date="2014-10-15"></event></eventGroup><numberingGroup><numbering type="pageFirst" number="137">137</numbering><numbering type="pageLast" number="145">145</numbering></numberingGroup><linkGroup><link type="toTypesetVersion" href="file:AJO.AJO137.pdf"></link></linkGroup></publicationMeta><contentMeta><countGroup><count type="referenceTotal" number="35"></count><count type="linksCrossRef" number="4"></count></countGroup><titleGroup><title type="main">Invasive Squamous Cell Carcinoma of the Vulva: Behaviour and Results in the Light of Changing Management Regimens</title><title type="subtitle">A review of clinicohistological features predictive of regional lymph node involvement and local recurrence</title></titleGroup><creators><creator creatorRole="author" xml:id="cr1" affiliationRef="#a1"><personName><givenNames>D.</givenNames><familyName>Lingard</familyName></personName></creator><creator creatorRole="author" xml:id="cr2" affiliationRef="#a1"><personName><givenNames>K.</givenNames><familyName>Free</familyName></personName></creator><creator creatorRole="author" xml:id="cr3" affiliationRef="#a2"><personName><givenNames>R. G.</givenNames><familyName>Wright</familyName></personName></creator><creator creatorRole="author" xml:id="cr4" affiliationRef="#a3"><personName><givenNames>D.</givenNames><familyName>Battistutta</familyName></personName></creator></creators><affiliationGroup><affiliation xml:id="a1"><unparsedAffiliation>Departments of Gynaecologic Oncology, Brisbane</unparsedAffiliation></affiliation><affiliation xml:id="a2"><unparsedAffiliation>Departments of Pathology, Royal Brisbane Hospital, Brisbane</unparsedAffiliation></affiliation><affiliation xml:id="a3"><unparsedAffiliation>Queensland Institute of Medical Research, Brisbane</unparsedAffiliation></affiliation></affiliationGroup><abstractGroup><abstract type="main" xml:lang="en"><p> <b>EDITORIAL COMMENT</b>: We accepted this paper for publication because detailed analysis of results in 90 cases of invasive carcinoma of the vulva treated by one team of surgeons in a 10‐year period provides important information for those who must decide how to treat women with these lesions. The legends to Figure IA and B present an anecdotal case illustrating that even aged women with invasive cancer merit consideration of radical surgery.</p><p><b>Summary: </b> Ninety‐nine patients with carcinoma of the vulva were referred to the Gynaecologic Oncology Unit, Royal Brisbane Hospital, over 10 years. Ninety of these patients had a squamous cell carcinoma (SCC). They were assessed by the 1969 FIGO clinical staging. Each stage was related to nodal involvement, size, depth, histological grade, lymphvascular space involvement, perineural permeation and multifocal disease site. The operability rate was 85%. Treatment was individualized in line with recent philosophies for more conservative surgery where appropriate. Mortality was 2.6%. Five‐year survival of surgically treated patients was 60.3%; node negative patients 100%, and node positive patients 25.2%. After adjustment for stage and size, the only other independent statistically significant feature was perineural penetration. Local recurrence was more likely with increased stage and size, unclear margins and multifocal involvement. It is important to note that medically unfit patients who had vulvectomy alone and who later developed positive nodes had 100% mortality. This group of patients significantly decreases survival rates, confirming the importance of carrying out inguinofemoral lymphadenectomy at the time of initial surgery. Morbidity was decreased by conservative surgery. Lymphoedema remains the most common chronic complication. No significant difference was shown in local recurrence between different types of surgery, wide excision, hemivulvectomy, simple vulvectomy or radical vulvectomy (22%), confirming the safety of the more conservative approach of recent years.</p></abstract></abstractGroup></contentMeta></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Invasive Squamous Cell Carcinoma of the Vulva: Behaviour and Results in the Light of Changing Management Regimens</title><subTitle>A review of clinicohistological features predictive of regional lymph node involvement and local recurrence</subTitle></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Invasive Squamous Cell Carcinoma of the Vulva: Behaviour and Results in the Light of Changing Management Regimens</title></titleInfo><name type="personal"><namePart type="given">D.</namePart><namePart type="family">Lingard</namePart><affiliation>Departments of Gynaecologic Oncology, Brisbane</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">K.</namePart><namePart type="family">Free</namePart><affiliation>Departments of Gynaecologic Oncology, Brisbane</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">R. G.</namePart><namePart type="family">Wright</namePart><affiliation>Departments of Pathology, Royal Brisbane Hospital, Brisbane</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">D.</namePart><namePart type="family">Battistutta</namePart><affiliation>Queensland Institute of Medical Research, Brisbane</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="review-article" displayLabel="reviewArticle"></genre><originInfo><publisher>Blackwell Publishing Ltd</publisher><place><placeTerm type="text">Oxford, UK</placeTerm></place><dateIssued encoding="w3cdtf">1992-05</dateIssued><copyrightDate encoding="w3cdtf">1992</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="references">35</extent></physicalDescription><abstract>EDITORIAL COMMENT: We accepted this paper for publication because detailed analysis of results in 90 cases of invasive carcinoma of the vulva treated by one team of surgeons in a 10‐year period provides important information for those who must decide how to treat women with these lesions. The legends to Figure IA and B present an anecdotal case illustrating that even aged women with invasive cancer merit consideration of radical surgery.</abstract><abstract>Summary: Ninety‐nine patients with carcinoma of the vulva were referred to the Gynaecologic Oncology Unit, Royal Brisbane Hospital, over 10 years. Ninety of these patients had a squamous cell carcinoma (SCC). They were assessed by the 1969 FIGO clinical staging. Each stage was related to nodal involvement, size, depth, histological grade, lymphvascular space involvement, perineural permeation and multifocal disease site. The operability rate was 85%. Treatment was individualized in line with recent philosophies for more conservative surgery where appropriate. Mortality was 2.6%. Five‐year survival of surgically treated patients was 60.3%; node negative patients 100%, and node positive patients 25.2%. After adjustment for stage and size, the only other independent statistically significant feature was perineural penetration. Local recurrence was more likely with increased stage and size, unclear margins and multifocal involvement. It is important to note that medically unfit patients who had vulvectomy alone and who later developed positive nodes had 100% mortality. This group of patients significantly decreases survival rates, confirming the importance of carrying out inguinofemoral lymphadenectomy at the time of initial surgery. Morbidity was decreased by conservative surgery. Lymphoedema remains the most common chronic complication. No significant difference was shown in local recurrence between different types of surgery, wide excision, hemivulvectomy, simple vulvectomy or radical vulvectomy (22%), confirming the safety of the more conservative approach of recent years.</abstract><relatedItem type="host"><titleInfo><title>Australian and New Zealand Journal of Obstetrics and Gynaecology</title></titleInfo><genre type="journal">journal</genre><identifier type="ISSN">0004-8666</identifier><identifier type="eISSN">1479-828X</identifier><identifier type="DOI">10.1111/(ISSN)1479-828X</identifier><identifier type="PublisherID">AJO</identifier><part><date>1992</date><detail type="volume"><caption>vol.</caption><number>32</number></detail><detail type="issue"><caption>no.</caption><number>2</number></detail><extent unit="pages"><start>137</start><end>145</end><total>9</total></extent></part></relatedItem><identifier type="istex">72829199C9B45ADB71F2F49A20D8B37990E4982C</identifier><identifier type="DOI">10.1111/j.1479-828X.1992.tb01926.x</identifier><identifier type="ArticleID">AJO137</identifier><recordInfo><recordContentSource>WILEY</recordContentSource><recordOrigin>Blackwell Publishing Ltd</recordOrigin></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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