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Debate 48A - Should the Subsequent Management of Patients with Vulvar Cancer and a Positive Sentinel Lymph Node be Complete Groin Lymph Node Dissection or Radiation Therapy?

Dissection

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

Sentinel lymph node (SLN) biopsy is the standard of care for assessing groin nodes in early-stage vulvar cancer, reducing significant morbidity compared to complete inguinofemoral lymph node dissection (IFLD). Adjuvant radiation therapy continues to be an important treatment for those with positive groin nodes. Although patients with a negative SLN can be observed, those with a positive SLN typically undergo a complete IFLD as the next step in management which can introduce increased surgical morbidity and complications. It is tempting to avoid IFLD and give adjuvant radiation therapy instead, raising question whether radiation is a reasonable management plan when there is a positive SLN. However, the data presented here will demonstrate that at present time surgical resection should not be omitted and should remain the standard of care, as radiation therapy alone in positive macrometastatic groin nodes increases risk of groin recurrence which leads to a dismal prognosis.

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Publisher: Cambridge University Press
Print publication year: 2023

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References

Van der Zee AGJ, et al. Sentinel node dissection is safe in the treatment of early-stage vulvar cancer. J Clin Oncol 2008;26:884889.CrossRefGoogle Scholar
Levenback, CF, et al. Lymphatic mapping and sentinel lymph node biopsy in women with squamous cell carcinoma of the vulva: a Gynecologic Oncology Group study. J Clin Oncol 2012;30:37863791.CrossRefGoogle ScholarPubMed
Stehman, FB, et al. Groin dissection vs groin radiation in carcinoma of the vulva: a Gynecologic Oncology Group study. Int J Rad Oncol Biol Phys 1992;24:389396.CrossRefGoogle Scholar
Oonk, MHM, et al. Size of sentinel-node metastasis and chances of non-sentinel-node involvement and survival in early-stage vulvar cancer: results from GROINSS-V, a multicentre observational study. Lancet Oncol 2010;11:646652.CrossRefGoogle ScholarPubMed
Oonk, MHM, et al. Radiotherapy instead of inguinofemoral lymphadenectomy in vulvar cancer patients with a metastatic sentinel node: results of GROINSS-V II. Int J Gynecol Cancer 2019;29(Suppl. 4):A14.Google Scholar

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