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
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">Prophylactic Chemoradiation of Inguinofemoral Lymph Nodes in Patients with Locally Extensive Vulvar Cancer</title><author><name sortKey="Leiserowitz, Gary S" sort="Leiserowitz, Gary S" uniqKey="Leiserowitz G" first="Gary S." last="Leiserowitz">Gary S. Leiserowitz</name><affiliation><mods:affiliation>Department of Obstetrics and Gynecology, University of California, Davis Medical Center, Sacramento, California, 95816</mods:affiliation></affiliation></author><author><name sortKey="Russell, Anthony H" sort="Russell, Anthony H" uniqKey="Russell A" first="Anthony H." last="Russell">Anthony H. Russell</name><affiliation><mods:affiliation>Radiation Oncology Centers of Northern California, Radiological Associates of Sacramento Medical Group, Sacramento, California, 95816</mods:affiliation></affiliation></author><author><name sortKey="Kinney, Walter K" sort="Kinney, Walter K" uniqKey="Kinney W" first="Walter K." last="Kinney">Walter K. Kinney</name><affiliation><mods:affiliation>Permanente Medical Group, Sacramento, California, 95825</mods:affiliation></affiliation></author><author><name sortKey="Smith, Lloyd H" sort="Smith, Lloyd H" uniqKey="Smith L" first="Lloyd H." last="Smith">Lloyd H. Smith</name><affiliation><mods:affiliation>Department of Obstetrics and Gynecology, University of California, Davis Medical Center, Sacramento, California, 95816</mods:affiliation></affiliation></author><author><name sortKey="Taylor, Michael H" sort="Taylor, Michael H" uniqKey="Taylor M" first="Michael H." last="Taylor">Michael H. 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Scudder</name><affiliation><mods:affiliation>Division of Hematology/Oncology, University of California, Davis Medical Center, Sacramento, California, 95816</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:BF41A75230D6C5194199EB0BCB1ADD9491D8A501</idno><date when="1997" year="1997">1997</date><idno type="doi">10.1006/gyno.1997.4804</idno><idno type="url">https://api.istex.fr/document/BF41A75230D6C5194199EB0BCB1ADD9491D8A501/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">005991</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">005991</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Prophylactic Chemoradiation of Inguinofemoral Lymph Nodes in Patients with Locally Extensive Vulvar Cancer</title><author><name sortKey="Leiserowitz, Gary S" sort="Leiserowitz, Gary S" uniqKey="Leiserowitz G" first="Gary S." last="Leiserowitz">Gary S. Leiserowitz</name><affiliation><mods:affiliation>Department of Obstetrics and Gynecology, University of California, Davis Medical Center, Sacramento, California, 95816</mods:affiliation></affiliation></author><author><name sortKey="Russell, Anthony H" sort="Russell, Anthony H" uniqKey="Russell A" first="Anthony H." last="Russell">Anthony H. Russell</name><affiliation><mods:affiliation>Radiation Oncology Centers of Northern California, Radiological Associates of Sacramento Medical Group, Sacramento, California, 95816</mods:affiliation></affiliation></author><author><name sortKey="Kinney, Walter K" sort="Kinney, Walter K" uniqKey="Kinney W" first="Walter K." last="Kinney">Walter K. Kinney</name><affiliation><mods:affiliation>Permanente Medical Group, Sacramento, California, 95825</mods:affiliation></affiliation></author><author><name sortKey="Smith, Lloyd H" sort="Smith, Lloyd H" uniqKey="Smith L" first="Lloyd H." last="Smith">Lloyd H. Smith</name><affiliation><mods:affiliation>Department of Obstetrics and Gynecology, University of California, Davis Medical Center, Sacramento, California, 95816</mods:affiliation></affiliation></author><author><name sortKey="Taylor, Michael H" sort="Taylor, Michael H" uniqKey="Taylor M" first="Michael H." last="Taylor">Michael H. Taylor</name><affiliation><mods:affiliation>Mercy San Juan Hospital, Carmichael, California, 95608</mods:affiliation></affiliation></author><author><name sortKey="Scudder, Sidney A" sort="Scudder, Sidney A" uniqKey="Scudder S" first="Sidney A." last="Scudder">Sidney A. Scudder</name><affiliation><mods:affiliation>Division of Hematology/Oncology, University of California, Davis Medical Center, Sacramento, California, 95816</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Gynecologic Oncology</title><title level="j" type="abbrev">YGYNO</title><idno type="ISSN">0090-8258</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1997">1997</date><biblScope unit="volume">66</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="509">509</biblScope><biblScope unit="page" to="514">514</biblScope></imprint><idno type="ISSN">0090-8258</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0090-8258</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><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></front></TEI><istex><corpusName>elsevier</corpusName><keywords><teeft><json:string>node</json:string><json:string>vulva</json:string><json:string>midline</json:string><json:string>chemoradiation</json:string><json:string>chemotherapy</json:string><json:string>vulvar</json:string><json:string>oncol</json:string><json:string>groin nodes</json:string><json:string>elective</json:string><json:string>inguinal</json:string><json:string>gynecol</json:string><json:string>squamous</json:string><json:string>vulvar cancer</json:string><json:string>femoral</json:string><json:string>inguinofemoral</json:string><json:string>oncology</json:string><json:string>carcinoma</json:string><json:string>photon</json:string><json:string>gynecol oncol</json:string><json:string>groin</json:string><json:string>radiotherapy</json:string><json:string>exenteration</json:string><json:string>gynecologic</json:string><json:string>squamous cancer</json:string><json:string>radiation therapy</json:string><json:string>groin dissection</json:string><json:string>radiat oncol biol phys</json:string><json:string>recurrence</json:string><json:string>malignancy</json:string><json:string>anal canal</json:string><json:string>favorable results</json:string><json:string>elective radiation</json:string><json:string>radiation dose</json:string><json:string>femoral artery</json:string><json:string>inguinofemoral nodes</json:string><json:string>aseptic necrosis</json:string><json:string>initial treatment</json:string><json:string>daily fractionation</json:string><json:string>uninvolved groin nodes</json:string><json:string>residual disease</json:string><json:string>local excision</json:string><json:string>epithelial malignancies</json:string><json:string>elective groin radiation</json:string><json:string>primary cancer</json:string><json:string>groin radiation</json:string><json:string>squamous cancers</json:string><json:string>midline structures</json:string><json:string>radical vulvectomy</json:string><json:string>inguinal nodes</json:string><json:string>needle aspiration</json:string><json:string>academic press</json:string><json:string>effective therapy</json:string><json:string>femoral necks</json:string><json:string>elective chemoradiation</json:string><json:string>transmission block</json:string><json:string>inguinal ligament</json:string><json:string>initial chemoradiation</json:string><json:string>untreated patients</json:string><json:string>primary vulvar cancer</json:string><json:string>treatment volume</json:string><json:string>primary site</json:string><json:string>local relapse</json:string><json:string>intercurrent disease</json:string><json:string>heavy smoker</json:string><json:string>patient characteristics</json:string><json:string>subsequent groin surgery</json:string><json:string>groin node</json:string><json:string>target volume</json:string><json:string>gynecologic oncology group study</json:string><json:string>elective inclusion</json:string><json:string>larger group</json:string><json:string>cytotoxic chemotherapy</json:string><json:string>synchronous radiation</json:string><json:string>radiological associates</json:string><json:string>northern california</json:string><json:string>obstet gynecol</json:string><json:string>radiation oncology centers</json:string><json:string>inguinofemoral lymph nodes</json:string><json:string>prophylactic chemoradiation</json:string><json:string>clin oncol</json:string></teeft></keywords><author><json:item><name>Gary S. Leiserowitz M.D.</name><affiliations><json:string>Department of Obstetrics and Gynecology, University of California, Davis Medical Center, Sacramento, California, 95816</json:string></affiliations></json:item><json:item><name>Anthony H. Russell M.D.</name><affiliations><json:string>Radiation Oncology Centers of Northern California, Radiological Associates of Sacramento Medical Group, Sacramento, California, 95816</json:string></affiliations></json:item><json:item><name>Walter K. Kinney M.D.</name><affiliations><json:string>Permanente Medical Group, Sacramento, California, 95825</json:string></affiliations></json:item><json:item><name>Lloyd H. Smith M.D., Ph.D.</name><affiliations><json:string>Department of Obstetrics and Gynecology, University of California, Davis Medical Center, Sacramento, California, 95816</json:string></affiliations></json:item><json:item><name>Michael H. Taylor M.D.</name><affiliations><json:string>Mercy San Juan Hospital, Carmichael, California, 95608</json:string></affiliations></json:item><json:item><name>Sidney A. Scudder M.D</name><affiliations><json:string>Division of Hematology/Oncology, University of California, Davis Medical Center, Sacramento, California, 95816</json:string></affiliations></json:item></author><language><json:string>eng</json:string></language><originalGenre><json:string>Full-length article</json:string></originalGenre><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.</abstract><qualityIndicators><score>6.883</score><pdfVersion>1.1</pdfVersion><pdfPageSize>548 x 724 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>0</keywordCount><abstractCharCount>2038</abstractCharCount><pdfWordCount>3883</pdfWordCount><pdfCharCount>25267</pdfCharCount><pdfPageCount>6</pdfPageCount><abstractWordCount>289</abstractWordCount></qualityIndicators><title>Prophylactic Chemoradiation of Inguinofemoral Lymph Nodes in Patients with Locally Extensive Vulvar Cancer</title><pii><json:string>S0090-8258(97)94804-6</json:string></pii><genre><json:string>research-article</json:string></genre><host><title>Gynecologic 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medicales</json:string></inist></categories><publicationDate>1997</publicationDate><copyrightDate>1997</copyrightDate><doi><json:string>10.1006/gyno.1997.4804</json:string></doi><id>BF41A75230D6C5194199EB0BCB1ADD9491D8A501</id><score>1</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/BF41A75230D6C5194199EB0BCB1ADD9491D8A501/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/BF41A75230D6C5194199EB0BCB1ADD9491D8A501/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/BF41A75230D6C5194199EB0BCB1ADD9491D8A501/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Prophylactic Chemoradiation of Inguinofemoral Lymph Nodes in Patients with Locally Extensive Vulvar Cancer</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>ELSEVIER</publisher><availability><p>©1997 Academic Press</p></availability><date>1997</date></publicationStmt><notesStmt><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></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Prophylactic Chemoradiation of Inguinofemoral Lymph Nodes in Patients with Locally Extensive Vulvar Cancer</title><author xml:id="author-0000"><persName><forename type="first">Gary S.</forename><surname>Leiserowitz</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Department of Obstetrics and Gynecology, University of California, Davis Medical Center, Sacramento, California, 95816</affiliation></author><author xml:id="author-0001"><persName><forename type="first">Anthony H.</forename><surname>Russell</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Radiation Oncology Centers of Northern California, Radiological Associates of Sacramento Medical Group, Sacramento, California, 95816</affiliation></author><author xml:id="author-0002"><persName><forename type="first">Walter K.</forename><surname>Kinney</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Permanente Medical Group, Sacramento, California, 95825</affiliation></author><author xml:id="author-0003"><persName><forename type="first">Lloyd H.</forename><surname>Smith</surname></persName><roleName type="degree">M.D., Ph.D.</roleName><affiliation>Department of Obstetrics and Gynecology, University of California, Davis Medical Center, Sacramento, California, 95816</affiliation></author><author xml:id="author-0004"><persName><forename type="first">Michael H.</forename><surname>Taylor</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Mercy San Juan Hospital, Carmichael, California, 95608</affiliation></author><author xml:id="author-0005"><persName><forename type="first">Sidney A.</forename><surname>Scudder</surname></persName><roleName type="degree">M.D</roleName><affiliation>Division of Hematology/Oncology, University of California, Davis Medical Center, Sacramento, California, 95816</affiliation></author><idno type="istex">BF41A75230D6C5194199EB0BCB1ADD9491D8A501</idno><idno type="DOI">10.1006/gyno.1997.4804</idno><idno type="PII">S0090-8258(97)94804-6</idno></analytic><monogr><title level="j">Gynecologic Oncology</title><title level="j" type="abbrev">YGYNO</title><idno type="pISSN">0090-8258</idno><idno type="PII">S0090-8258(00)X0056-X</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1997"></date><biblScope unit="volume">66</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="509">509</biblScope><biblScope unit="page" to="514">514</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>1997</date></creation><langUsage><language ident="en">en</language></langUsage><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></abstract></profileDesc><revisionDesc><change when="1997">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/BF41A75230D6C5194199EB0BCB1ADD9491D8A501/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Elsevier, elements deleted: tail"><istex:xmlDeclaration>version="1.0" encoding="utf-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//ES//DTD journal article DTD version 4.5.2//EN//XML" URI="art452.dtd" name="istex:docType"></istex:docType><istex:document><converted-article version="4.5.2" docsubtype="fla" xml:lang="en"><item-info><jid>YGYNO</jid><aid>94804</aid><ce:pii>S0090-8258(97)94804-6</ce:pii><ce:doi>10.1006/gyno.1997.4804</ce:doi><ce:copyright type="full-transfer" year="1997">Academic Press</ce:copyright></item-info><head><ce:article-footnote><ce:label>☆</ce:label><ce:note-para>Presented at the 15th Annual Meeting of the Western Association of Gynecologic Oncologists, Whistler, British Columbia, Canada, June 1994.</ce:note-para></ce:article-footnote><ce:dochead><ce:textfn>Regular Article</ce:textfn></ce:dochead><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></converted-article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Prophylactic Chemoradiation of Inguinofemoral Lymph Nodes in Patients with Locally Extensive Vulvar Cancer</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Prophylactic Chemoradiation of Inguinofemoral Lymph Nodes in Patients with Locally Extensive Vulvar Cancer</title></titleInfo><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></role></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></role></name><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><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="Full-length article"></genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">1997</dateIssued><copyrightDate encoding="w3cdtf">1997</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><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></titleInfo><titleInfo type="abbreviated"><title>YGYNO</title></titleInfo><genre type="journal">journal</genre><originInfo><dateIssued encoding="w3cdtf">199709</dateIssued></originInfo><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></detail><detail type="issue"><number>3</number><caption>no.</caption></detail><extent unit="issue pages"><start>351</start><end>547</end></extent><extent unit="pages"><start>509</start><end>514</end></extent></part></relatedItem><identifier type="istex">BF41A75230D6C5194199EB0BCB1ADD9491D8A501</identifier><identifier type="DOI">10.1006/gyno.1997.4804</identifier><identifier type="PII">S0090-8258(97)94804-6</identifier><accessCondition type="use and reproduction" contentType="copyright">©1997 Academic Press</accessCondition><recordInfo><recordContentSource>ELSEVIER</recordContentSource><recordOrigin>Academic Press, ©1997</recordOrigin></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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