Prophylactic Chemoradiation of Inguinofemoral Lymph Nodes in Patients with Locally Extensive Vulvar Cancer
Identifieur interne : 005991 ( Istex/Corpus ); précédent : 005990; suivant : 005992Prophylactic Chemoradiation of Inguinofemoral Lymph Nodes in Patients with Locally Extensive Vulvar Cancer
Auteurs : Gary S. Leiserowitz ; Anthony H. Russell ; Walter K. Kinney ; Lloyd H. Smith ; Michael H. Taylor ; Sidney A. ScudderSource :
- Gynecologic Oncology [ 0090-8258 ] ; 1997.
Abstract
Objective.Primary surgical resection of locally advanced squamous cancer of the vulva may compromise the integrity of important midline structures such as the anus, clitoris, urethra, and vagina. Chemoradiation (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 associated with substantial risk of both acute and late morbidity, prompting consideration of elective inclusion of groin nodes within the irradiated volume and deletion of subsequent groin surgery. Concern that disease relapse in the groins is potentially fatal suggested the prudence of formal outcome assessment of our recent experience with prophylactic treatment of clinically uninvolved groin nodes in the context of concurrent chemoradiation for locally advanced primary vulvar cancer. Methods.A review was conducted of 23 previously untreated patients with locally advanced squamous cancer of the vulva (2 T2, 20 T3, 1 T4) and clinically uninvolved groin nodes (1969 FIGO stages 14 N0, 4 N1, and 5 N2with negative node biopsies) who were treated since 1987 with chemoradiation administered to a volume electively including bilateral inguinofemoral nodes. These patients did not undergo subsequent groin surgery. Results.With follow-up from 6 to 98 months (mean, 45.3 months; median, 42 months), no patient has failed in the prophylactically irradiated inguinofemoral nodes. No patient has developed lymphedema, vascular insufficiency, or neurological injury in a lower extremity, and no patient has experienced aseptic necrosis of a femur. Conclusions.Elective irradiation of the groin nodes in the context of initial chemoradiation for locally advanced vulvar cancer is an effective therapy associated with acceptable acute toxicity and minimal late sequelae. It constitutes a sensible alternative to groin dissection in this patient population.
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DOI: 10.1006/gyno.1997.4804
Links to Exploration step
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<front><div type="abstract" xml:lang="en">Objective.Primary surgical resection of locally advanced squamous cancer of the vulva may compromise the integrity of important midline structures such as the anus, clitoris, urethra, and vagina. Chemoradiation (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 associated with substantial risk of both acute and late morbidity, prompting consideration of elective inclusion of groin nodes within the irradiated volume and deletion of subsequent groin surgery. Concern that disease relapse in the groins is potentially fatal suggested the prudence of formal outcome assessment of our recent experience with prophylactic treatment of clinically uninvolved groin nodes in the context of concurrent chemoradiation for locally advanced primary vulvar cancer. Methods.A review was conducted of 23 previously untreated patients with locally advanced squamous cancer of the vulva (2 T2, 20 T3, 1 T4) and clinically uninvolved groin nodes (1969 FIGO stages 14 N0, 4 N1, and 5 N2with negative node biopsies) who were treated since 1987 with chemoradiation administered to a volume electively including bilateral inguinofemoral nodes. These patients did not undergo subsequent groin surgery. Results.With follow-up from 6 to 98 months (mean, 45.3 months; median, 42 months), no patient has failed in the prophylactically irradiated inguinofemoral nodes. No patient has developed lymphedema, vascular insufficiency, or neurological injury in a lower extremity, and no patient has experienced aseptic necrosis of a femur. Conclusions.Elective irradiation of the groin nodes in the context of initial chemoradiation for locally advanced vulvar cancer is an effective therapy associated with acceptable acute toxicity and minimal late sequelae. It constitutes a sensible alternative to groin dissection in this patient population.</div>
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<abstract xml:lang="en"><p>Objective.Primary surgical resection of locally advanced squamous cancer of the vulva may compromise the integrity of important midline structures such as the anus, clitoris, urethra, and vagina. Chemoradiation (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 associated with substantial risk of both acute and late morbidity, prompting consideration of elective inclusion of groin nodes within the irradiated volume and deletion of subsequent groin surgery. Concern that disease relapse in the groins is potentially fatal suggested the prudence of formal outcome assessment of our recent experience with prophylactic treatment of clinically uninvolved groin nodes in the context of concurrent chemoradiation for locally advanced primary vulvar cancer. Methods.A review was conducted of 23 previously untreated patients with locally advanced squamous cancer of the vulva (2 T2, 20 T3, 1 T4) and clinically uninvolved groin nodes (1969 FIGO stages 14 N0, 4 N1, and 5 N2with negative node biopsies) who were treated since 1987 with chemoradiation administered to a volume electively including bilateral inguinofemoral nodes. These patients did not undergo subsequent groin surgery. Results.With follow-up from 6 to 98 months (mean, 45.3 months; median, 42 months), no patient has failed in the prophylactically irradiated inguinofemoral nodes. No patient has developed lymphedema, vascular insufficiency, or neurological injury in a lower extremity, and no patient has experienced aseptic necrosis of a femur. Conclusions.Elective irradiation of the groin nodes in the context of initial chemoradiation for locally advanced vulvar cancer is an effective therapy associated with acceptable acute toxicity and minimal late sequelae. It constitutes a sensible alternative to groin dissection in this patient population.</p>
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<ce:dochead><ce:textfn>Regular Article</ce:textfn>
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<ce:title>Prophylactic Chemoradiation of Inguinofemoral Lymph Nodes in Patients with Locally Extensive Vulvar Cancer</ce:title>
<ce:author-group><ce:author><ce:given-name>Gary S.</ce:given-name>
<ce:surname>Leiserowitz</ce:surname>
<ce:degrees>M.D.</ce:degrees>
<ce:cross-ref refid="GO974804A1"><ce:sup>a</ce:sup>
</ce:cross-ref>
</ce:author>
<ce:author><ce:given-name>Anthony H.</ce:given-name>
<ce:surname>Russell</ce:surname>
<ce:degrees>M.D.</ce:degrees>
<ce:cross-ref refid="GO974804A2"><ce:sup>b</ce:sup>
</ce:cross-ref>
</ce:author>
<ce:author><ce:given-name>Walter K.</ce:given-name>
<ce:surname>Kinney</ce:surname>
<ce:degrees>M.D.</ce:degrees>
<ce:cross-ref refid="GO974804A3"><ce:sup>c</ce:sup>
</ce:cross-ref>
</ce:author>
<ce:author><ce:given-name>Lloyd H.</ce:given-name>
<ce:surname>Smith</ce:surname>
<ce:degrees>M.D., Ph.D.</ce:degrees>
<ce:cross-ref refid="GO974804A1"><ce:sup>a</ce:sup>
</ce:cross-ref>
</ce:author>
<ce:author><ce:given-name>Michael H.</ce:given-name>
<ce:surname>Taylor</ce:surname>
<ce:degrees>M.D.</ce:degrees>
<ce:cross-ref refid="GO974804A4"><ce:sup>d</ce:sup>
</ce:cross-ref>
</ce:author>
<ce:author><ce:given-name>Sidney A.</ce:given-name>
<ce:surname>Scudder</ce:surname>
<ce:degrees>M.D</ce:degrees>
<ce:cross-ref refid="GO974804A5"><ce:sup>e</ce:sup>
</ce:cross-ref>
</ce:author>
<ce:affiliation id="GO974804A1"><ce:label>a</ce:label>
<ce:textfn>Department of Obstetrics and Gynecology, University of California, Davis Medical Center, Sacramento, California, 95816</ce:textfn>
</ce:affiliation>
<ce:affiliation id="GO974804A5"><ce:label>e</ce:label>
<ce:textfn>Division of Hematology/Oncology, University of California, Davis Medical Center, Sacramento, California, 95816</ce:textfn>
</ce:affiliation>
<ce:affiliation id="GO974804A2"><ce:label>b</ce:label>
<ce:textfn>Radiation Oncology Centers of Northern California, Radiological Associates of Sacramento Medical Group, Sacramento, California, 95816</ce:textfn>
</ce:affiliation>
<ce:affiliation id="GO974804A3"><ce:label>c</ce:label>
<ce:textfn>Permanente Medical Group, Sacramento, California, 95825</ce:textfn>
</ce:affiliation>
<ce:affiliation id="GO974804A4"><ce:label>d</ce:label>
<ce:textfn>Mercy San Juan Hospital, Carmichael, California, 95608</ce:textfn>
</ce:affiliation>
</ce:author-group>
<ce:date-received day="24" month="3" year="1997"></ce:date-received>
<ce:abstract><ce:section-title>Abstract</ce:section-title>
<ce:abstract-sec><ce:simple-para><ce:italic>Objective.</ce:italic>
Primary surgical resection of locally advanced squamous cancer of the vulva may compromise the integrity of important midline structures such as the anus, clitoris, urethra, and vagina. Chemoradiation (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 associated with substantial risk of both acute and late morbidity, prompting consideration of elective inclusion of groin nodes within the irradiated volume and deletion of subsequent groin surgery. Concern that disease relapse in the groins is potentially fatal suggested the prudence of formal outcome assessment of our recent experience with prophylactic treatment of clinically uninvolved groin nodes in the context of concurrent chemoradiation for locally advanced primary vulvar cancer.</ce:simple-para>
<ce:simple-para><ce:italic>Methods.</ce:italic>
A review was conducted of 23 previously untreated patients with locally advanced squamous cancer of the vulva (2 T<ce:inf>2</ce:inf>
, 20 T<ce:inf>3</ce:inf>
, 1 T<ce:inf>4</ce:inf>
) and clinically uninvolved groin nodes (1969 FIGO stages 14 N<ce:inf>0</ce:inf>
, 4 N<ce:inf>1</ce:inf>
, and 5 N<ce:inf>2</ce:inf>
with negative node biopsies) who were treated since 1987 with chemoradiation administered to a volume electively including bilateral inguinofemoral nodes. These patients did not undergo subsequent groin surgery.</ce:simple-para>
<ce:simple-para><ce:italic>Results.</ce:italic>
With follow-up from 6 to 98 months (mean, 45.3 months; median, 42 months), no patient has failed in the prophylactically irradiated inguinofemoral nodes. No patient has developed lymphedema, vascular insufficiency, or neurological injury in a lower extremity, and no patient has experienced aseptic necrosis of a femur.</ce:simple-para>
<ce:simple-para><ce:italic>Conclusions.</ce:italic>
Elective irradiation of the groin nodes in the context of initial chemoradiation for locally advanced vulvar cancer is an effective therapy associated with acceptable acute toxicity and minimal late sequelae. It constitutes a sensible alternative to groin dissection in this patient population.</ce:simple-para>
</ce:abstract-sec>
</ce:abstract>
</head>
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<mods version="3.6"><titleInfo lang="en"><title>Prophylactic Chemoradiation of Inguinofemoral Lymph Nodes in Patients with Locally Extensive Vulvar Cancer</title>
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<name type="personal"><namePart type="given">Gary S.</namePart>
<namePart type="family">Leiserowitz</namePart>
<namePart type="termsOfAddress">M.D.</namePart>
<affiliation>Department of Obstetrics and Gynecology, University of California, Davis Medical Center, Sacramento, California, 95816</affiliation>
<role><roleTerm type="text">author</roleTerm>
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</name>
<name type="personal"><namePart type="given">Anthony H.</namePart>
<namePart type="family">Russell</namePart>
<namePart type="termsOfAddress">M.D.</namePart>
<affiliation>Radiation Oncology Centers of Northern California, Radiological Associates of Sacramento Medical Group, Sacramento, California, 95816</affiliation>
<role><roleTerm type="text">author</roleTerm>
</role>
</name>
<name type="personal"><namePart type="given">Walter K.</namePart>
<namePart type="family">Kinney</namePart>
<namePart type="termsOfAddress">M.D.</namePart>
<affiliation>Permanente Medical Group, Sacramento, California, 95825</affiliation>
<role><roleTerm type="text">author</roleTerm>
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<name type="personal"><namePart type="given">Lloyd H.</namePart>
<namePart type="family">Smith</namePart>
<namePart type="termsOfAddress">M.D., Ph.D.</namePart>
<affiliation>Department of Obstetrics and Gynecology, University of California, Davis Medical Center, Sacramento, California, 95816</affiliation>
<role><roleTerm type="text">author</roleTerm>
</role>
</name>
<name type="personal"><namePart type="given">Michael H.</namePart>
<namePart type="family">Taylor</namePart>
<namePart type="termsOfAddress">M.D.</namePart>
<affiliation>Mercy San Juan Hospital, Carmichael, California, 95608</affiliation>
<role><roleTerm type="text">author</roleTerm>
</role>
</name>
<name type="personal"><namePart type="given">Sidney A.</namePart>
<namePart type="family">Scudder</namePart>
<namePart type="termsOfAddress">M.D</namePart>
<affiliation>Division of Hematology/Oncology, University of California, Davis Medical Center, Sacramento, California, 95816</affiliation>
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<dateIssued encoding="w3cdtf">1997</dateIssued>
<copyrightDate encoding="w3cdtf">1997</copyrightDate>
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<abstract lang="en">Objective.Primary surgical resection of locally advanced squamous cancer of the vulva may compromise the integrity of important midline structures such as the anus, clitoris, urethra, and vagina. Chemoradiation (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 associated with substantial risk of both acute and late morbidity, prompting consideration of elective inclusion of groin nodes within the irradiated volume and deletion of subsequent groin surgery. Concern that disease relapse in the groins is potentially fatal suggested the prudence of formal outcome assessment of our recent experience with prophylactic treatment of clinically uninvolved groin nodes in the context of concurrent chemoradiation for locally advanced primary vulvar cancer. Methods.A review was conducted of 23 previously untreated patients with locally advanced squamous cancer of the vulva (2 T2, 20 T3, 1 T4) and clinically uninvolved groin nodes (1969 FIGO stages 14 N0, 4 N1, and 5 N2with negative node biopsies) who were treated since 1987 with chemoradiation administered to a volume electively including bilateral inguinofemoral nodes. These patients did not undergo subsequent groin surgery. Results.With follow-up from 6 to 98 months (mean, 45.3 months; median, 42 months), no patient has failed in the prophylactically irradiated inguinofemoral nodes. No patient has developed lymphedema, vascular insufficiency, or neurological injury in a lower extremity, and no patient has experienced aseptic necrosis of a femur. Conclusions.Elective irradiation of the groin nodes in the context of initial chemoradiation for locally advanced vulvar cancer is an effective therapy associated with acceptable acute toxicity and minimal late sequelae. It constitutes a sensible alternative to groin dissection in this patient population.</abstract>
<note>Presented at the 15th Annual Meeting of the Western Association of Gynecologic Oncologists, Whistler, British Columbia, Canada, June 1994.</note>
<note type="content">Section title: Regular Article</note>
<relatedItem type="host"><titleInfo><title>Gynecologic Oncology</title>
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<titleInfo type="abbreviated"><title>YGYNO</title>
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<originInfo><dateIssued encoding="w3cdtf">199709</dateIssued>
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<identifier type="ISSN">0090-8258</identifier>
<identifier type="PII">S0090-8258(00)X0056-X</identifier>
<part><date>199709</date>
<detail type="volume"><number>66</number>
<caption>vol.</caption>
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<detail type="issue"><number>3</number>
<caption>no.</caption>
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<extent unit="issue pages"><start>351</start>
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<identifier type="PII">S0090-8258(97)94804-6</identifier>
<accessCondition type="use and reproduction" contentType="copyright">©1997 Academic Press</accessCondition>
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