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Debate 50B - Should Adjuvant Radiation Therapy be Given to Patients with Single Node Positive Vulvar Cancer?

No

from Section VI - Vaginal and Vulvar Cancer

Published online by Cambridge University Press:  20 July 2023

Dennis S. Chi
Affiliation:
Memorial Sloan-Kettering Cancer Center, New York
Nisha Lakhi
Affiliation:
Richmond University Medical Center, Staten Island
Nicoletta Colombo
Affiliation:
University of Milan-Bicocca
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Summary

Inguino-femoral lymph node metastasis in vulvar cancer accounts for increased risk of recurrence and 50% decrease in survival. Adjuvant radiotherapy for single positive IFLN vulvar cancer has persisted as a controversial topic since the publication of GOG 37. Retrospective data from Germany indicates that there is no difference in survival for patients with single node positive vulvar cancer treated with adjuvant radiotherapy or observation. Radical surgery, even with SLNB, followed by radiotherapy can lead to devastating and difficult-to-treat complications including wound infections, lymphedema, pain, and bone fractures. Considering these complications, overall quality of life, and the limited data demonstrating improved survival benefit, it would be beneficial to withhold adjuvant radiotherapy for patients with single-positive IFLN vulvar cancer. Further studies aimed at understanding the molecular landscape and investigating targeted and immunotherapy for vulvar cancer will aid in the treatment of this complex cancer.

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Publisher: Cambridge University Press
Print publication year: 2023

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References

Woelber, L, et al. Prognostic role of lymph node metastases in vulvar cancer and implications for adjuvant treatment. Int J Gynecol Cancer 2012;22(3):503508.CrossRefGoogle ScholarPubMed
Homesley, HD, et al. Radiation therapy versus pelvic node resection for carcinoma of the vulva with positive groin nodes. Obstet Gynecol 1986;68(6):733740.Google ScholarPubMed
Mahner, S, et al. Adjuvant therapy in lymph node-positive vulvar cancer: the AGO-CaRE-1 study. J Natl Cancer Inst 2015;107(3):dju426.CrossRefGoogle ScholarPubMed
Fons, G, et al. Adjuvant radiotherapy in patients with vulvar cancer and one intra capsular lymph node metastasis is not beneficial. Gynecol Oncol 2009;114(2):343345.Google Scholar
Parthasarathy, A, et al. The benefit of adjuvant radiation therapy in single-node-positive squamous cell vulvar carcinoma. Gynecol Oncol 2006;103(3):10951099.CrossRefGoogle ScholarPubMed

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