Medline ® Abstracts for References 2-4
of 'Radical vulvectomy'
Surgical-pathologic variables predictive of local recurrence in squamous cell carcinoma of the vulva.
Heaps JM, Fu YS, Montz FJ, Hacker NF, Berek JS
Gynecol Oncol. 1990;38(3):309.
One hundred and thirty-five patients with squamous carcinoma of the vulva were treated at UCLA and City of Hope Medical Centers between 1957 and 1985. Sixty-two cases were stage I, 48 stage II, 18 stage III, and 7 stage IV. Twenty-one patients developed a local vulvar recurrence after primary radical resection. Ninety-one patients had a surgical tumor-free margin greater than or equal to 8 mm on tissue section and none had a local vulvar recurrence. Forty-four patients had a margin less than 8 mm; 21 had a local recurrence and 23 did not (P less than 0.0001). Of the 23 patients with a margin less than 8 mm who did not recur locally, 14 remained free of disease, and 9 had either advanced disease, declining health, or short follow-up. Depth of invasion is associated with local recurrence, with a 9.1-mm reference value correctly predicting outcome in 81.5% of cases. Increasing tumor thickness is associated with local recurrence, with a 10-mm reference value predictive of 90% non-recurrence and 33% recurrences. A pushing border pattern is less likely to recur than an infiltrative growth pattern. Lymph-vascular space invasion has a combined predictive accuracy of 81.5%. Increasing keratin and greater than 10 mitoses per 10 high-power fields correlate with local recurrence. Neither clinical tumor size nor coexisting benign vulvar pathology correlates with local recurrence. Fourteen of twenty-one patients with vulvar recurrence died of metastatic disease, four died of intercurrent disease, and three were alive at 32, 68, and 157 months, with 16 recurring in less than 1 year. Surgical margin is the most powerful predictor of local vulvar recurrence. Combining factors in a stepwise logistical regression does not significantly improve this predictive value. Accounting for specimen preparation and fixation, a 1-cm tumor-free surgical margin on the vulva results in a high rate of local control, whereas a margin less than 8 mm is associated with a 50% chance of recurrence.
Department of Obstetrics and Gynecology, Jonsson Comprehensive Cancer Center, UCLA School of Medicine 90024.
Recurrent squamous cell carcinoma of the vulva: clinicopathologic determinants identifying low risk patients.
Preti M, Ronco G, Ghiringhello B, Micheletti L
BACKGROUND: The identification of prognostic factors in the recurrence of vulvar squamous cell carcinoma is crucial for less invasive treatments.
METHODS: The authors studied 101 patients treated for primary invasive squamous cell carcinoma of the vulva. Selected pathologic variables were observed in a standardized manner during treatment, and their association with disease free survival was investigated using the Cox model. Independent prognostic factors were selected by a stepwise procedure. The absolute survival of patient groups determined on the basis of such factors was computed by the product limit method.
RESULTS: The median follow-up was 3.1 years (range, 56 days to 15.5 years). Recurrences developed in 33 patients. The independent recurrence predictors were as follows: International Federation of Gynecology and Obstetrics (FIGO) Stage IVA (vs. IB, II, or III) (risk ratio [RR]adjusted for other independent factors, 7.39), tumor multifocality (RR, 4.10), lymphovascular space involvement (LVSI) (RR, 2.96), the presence of associated vulvar intraepithelial neoplasia (VIN) Grade 2 or 3 (RR, 3.34), and the involvement ofresection margins (RR, 4.88). By ignoring the FIGO stage and lymph node status, the independent predictors were then as follows: greatest tumor dimension<2.5 cm, 2.5-4 cm (RR, 2.86), or>4 cm (RR, 5.98); tumor multifocality (RR, 3.36); LVSI (RR, 4.19); the presence of VIN 2 or 3 (RR, 3.06); and the involvement of surgical margins (RR, 2.78). No recurrences were observed in 119 at-risk years among patients with unifocal tumors<2.5 cm in greatest dimension, free surgical margins, no LVSI, and no associated VIN 2 or 3.
CONCLUSIONS: The presence of associated VIN 2 or 3 was revealed to be a previously unidentified independent prognostic factor for recurrence. Subjects at low risk of recurrence could be identified even without consideration of lymph node status.
Department of Gynecology and Obstetrics, University of Turin, Turin, Italy. email@example.com
Conservative clitoral preservation surgery in the treatment of vulvar squamous cell carcinoma.
Chan JK, Sugiyama V, Tajalli TR, Pham H, Gu M, Rutgers J, Monk BJ
Gynecol Oncol. 2004;95(1):152.
OBJECTIVE: To determine the safety and efficacy of clitoral-sparing surgery in women with squamous cell carcinoma (SCCA) of the anterior vulva not involving the clitoris.
METHODS: Patients with vulvar SCCA diagnosed between 1984 and 2000 were identified and data collected. In this descriptive analysis, women treated with complete radical vulvectomy were compared to those treated with clitoral-sparing modified radical vulvectomy. All slides were re-reviewed.
RESULTS: Of the 41 women with vulvar carcinoma, 13 had clitoral-sparing modified vulvectomies (group A) while the remaining 28 underwent complete radical vulvectomies (group B). The 13 patients in group A included, 8 with stage I, 2 stage II, 2 stage III, and 1 with stage IV disease. The two groups had similar demographic and pathologic prognostic factors. After a median follow-up of 59 months, no patients in group A had loco-regional failure.
CONCLUSION: Clitoral-sparing vulvarcancer surgery does not compromise the rate of loco-regional control in patients and may be offered to selected women.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA 94305-5317, USA.