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Jankowski P, Findeklee S, Georgescu MT, Sima RM, Nigdelis MP, Solomayer EF, Klamminger GG, Hamoud BH. The Therapy of Vulvar Carcinoma-Evaluation of Surgical Options in a Retrospective Monocentric Study. Life (Basel) 2023; 13:1973. [PMID: 37895358 PMCID: PMC10608767 DOI: 10.3390/life13101973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/21/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Background: Surgical-oncological treatment methods are continuously put to the test in times of evidence-based medicine-notably, a constant reevaluation remains key, especially for tumor entities with increasing incidence such as vulvar carcinoma. (2) Methods: In order to determine the postoperative clinical course of different methods of vulvar excision (vulvectomy, hemivulvectomy) as well as inguinal lymph node removal (lymphadenectomy, sentinel lymph node biopsy) with regard to postoperative wound-healingprocess, perioperative hemorrhage, and re-resection rates, we retrospectively analyzed surgical, morphological and laboratory data of 76 patients with a pathological diagnosed vulvar cancer. (3) Results: Analysis of our data from a single center revealed a comparable perioperative clinical course regardless of the chosen method of vulvar excision and inguinal lymph node removal. (4) Conclusions: Thus, our results emphasize the current multimodality in surgical therapy of vulvar carcinoma, in which consideration of known prognostic factors together with the individual patient's clinical situation allow guideline-based therapy aimed at maximizing surgical safety.
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Affiliation(s)
- Peter Jankowski
- Department for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, 66421 Homburg, Germany
| | - Sebastian Findeklee
- Department for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, 66421 Homburg, Germany
| | - Mihai-Teodor Georgescu
- Department of Oncology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- “Prof. Dr. Alexandru Trestioreanu” Oncology Institute, 022328 Bucharest, Romania
| | - Romina Marina Sima
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- The “Bucur” Maternity, ‘Saint John’ Hospital, 040294 Bucharest, Romania
| | - Meletios P. Nigdelis
- Department for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, 66421 Homburg, Germany
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece
| | - Erich-Franz Solomayer
- Department for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, 66421 Homburg, Germany
| | - Gilbert Georg Klamminger
- Department for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, 66421 Homburg, Germany
| | - Bashar Haj Hamoud
- Department for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, 66421 Homburg, Germany
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Goyal LD, Kaur B, Bhalla S, Garg P. Carcinoma vulva: Ten years experience in a teaching institution of North India. J Family Med Prim Care 2023; 12:654-659. [PMID: 37312782 PMCID: PMC10259558 DOI: 10.4103/jfmpc.jfmpc_1731_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/09/2022] [Accepted: 11/17/2022] [Indexed: 06/15/2023] Open
Abstract
Introduction Vulvar carcinoma is primarily a disease of post-menopausal women. Surgery is a primary treatment strategy. Chemotherapy and radiotherapy are a part of multimodal therapy. Presently, there is a shift towards neoadjuvant chemotherapy or radiotherapy so as to decrease the surgical morbidities. Objective To study the surgical outcome and prognostic factors in Ca vulva patients. Methodology A retrospective analysis of 19 vulvar cancer patients, surgically treated at a teaching institution of Punjab (2009-2019). Results Mean age of the patients was 60.95 years. Ulcerative swelling (89.5%) over labia majora (73.7%) was the main presenting symptom. Radical vulvectomy-bilateral IFLN dissection was performed in 74% patients, hemivulvectomy-unilateral IFLN dissection in 21% patients and wide local excision in one patient. Squamous cell carcinoma was detected in all, and one had verrucous carcinoma. Thirty-seven per cent patients had FIGO stage III disease, 31.5% - stage II and 31.5% - stage I. On HPE, 78.57% (11/14) patients had positive nodes and two had ECS. Only 5/9 (55.5%) cases could receive PORT. Seven patients defaulted follow-up. Two developed nodal metastasis, and seven women developed recurrence. One patient with regional recurrence faced demise during RT course. In 10/19 regular follow-up patients, four are alive and disease free, five patients are on palliative chemoradiation, and one is undergoing adjuvant radiotherapy for regional recurrence. Estimated 5-year overall survival is 83.33%. Conclusion Tumour stage, nodal positivity and nodal ECS were poor prognostic factors. Radical surgery-extensive groin node dissection causes significant morbidity; hence, studies evaluating the role of neoadjuvant treatment are needed so as to modify current treatment practices. HPV vaccination as a preventive measure and a thorough and extensive evaluation of patients with suspicious signs in vulvar disease is needed.
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Affiliation(s)
- Lajya Devi Goyal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Balpreet Kaur
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Shivali Bhalla
- Department of Obstetrics and Gynaecology, Civil Hospital, Chandigarh, India
| | - Pardeep Garg
- Department of Radiation Oncology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
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van Doorn HC, Barroso EM, Koljenović S, Ewing-Graham PC, Soares MRN, van de Berg NJ, Schut TCB, Puppels GJ. Raman spectroscopy for guidance of vulvar cancer surgery: a pilot study. BIOMEDICAL OPTICS EXPRESS 2021; 12:3008-3020. [PMID: 34123511 PMCID: PMC8176800 DOI: 10.1364/boe.420882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/11/2021] [Accepted: 03/29/2021] [Indexed: 06/12/2023]
Abstract
For vulvar squamous cell carcinoma (VSCC), the mainstay of treatment is surgical removal with tumour-free margins. Surgeons still operate without objective tools that provide margin-status. This study assesses Raman spectroscopy potentiality for distinguishing ex-vivo VSCC from healthy tissue in 11 patients. Grid-based Raman maps were obtained from processed spectra. Water content and C-H band ratio (2,910-2,966 cm-1 / 2810-2890 cm-1) were calculated per spectrum and used as linear discriminant parameters. Healthy tissue was differentiated from VSCC with 0.90 discriminative power, 0.79 sensitivity and 0.86 specificity.This is an important step towards the development of objective tools for VSCC surgical guidance.
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Affiliation(s)
- Helena C. van Doorn
- Department of Gynaecologic Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- shared first authorship
| | - Elisa M. Barroso
- Department of Pathology, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
- shared first authorship
| | - Senada Koljenović
- Department of Pathology, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Patricia C. Ewing-Graham
- Department of Pathology, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M. Rosa N. Soares
- Department of Pathology, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Nick J. van de Berg
- Department of Gynaecologic Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Tom C. Bakker Schut
- Department of Dermatology, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Gerwin J. Puppels
- Department of Dermatology, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
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Heidkamp J, Zusterzeel PL, van Engen‐van Grunsven AC, Overduin CG, Veltien A, Maat A, Rovers MM, Fütterer JJ. MRI evaluation of vulvar squamous-cell carcinoma in fresh radical local excision specimens for cancer localization and prediction of surgical tumor-free margins. NMR IN BIOMEDICINE 2019; 32:e4025. [PMID: 30431192 PMCID: PMC6587990 DOI: 10.1002/nbm.4025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 08/30/2018] [Accepted: 09/19/2018] [Indexed: 06/09/2023]
Abstract
In the surgical treatment of vulvar squamous-cell carcinoma (VSCC), tumor-free margins of 8 mm or more are considered adequate. However, limited perioperative information on the tumor-free margins other than the surgeon's own estimation is available. The purpose of this study was therefore to investigate the feasibility of ex vivo MRI in localizing VSCC and to assess the surgical tumor-free margins in fresh radical local excision (RLE) specimens to guide the surgeon during resections. Nine patients with biopsy-proven VSCC scheduled for RLE were prospectively included. Intact fresh specimens were scanned using a 7 T preclinical MR-scanner. Whole mount H&E-stained slides were obtained every 3 mm and correlated with ex vivo MRI. A pathologist annotated VSCC and minimal tumor-free margins (3 o'clock, 9 o'clock, basal) on the digitalized histological slides. An observer with knowledge of histology (the non-blinded annotation) and a radiologist blinded to histology (the blinded annotation) separately performed annotation of the same features on ex vivo MRI. Linear correlation and agreement of the ex vivo MRI measurements with histology were assessed. Diagnostic performance for VSCC localization and identification of margins less than 8 mm was expressed as positive and negative predictive values (PPV, NPV). In 153 matched ex vivo MRI slices, the observer correctly identified 79/91 margins as less than 8 mm (PPV 87%) and 110/124 margins as 8 mm or greater (NPV 89%). The radiologist correctly annotated absence of VSCC in 73/81 (NPV 90%) and presence in 65/72 (PPV 90%) slices. Sixty-four of 90 margins were correctly identified as less than 8 mm (PPV 71%) and 83/102 margins as 8 mm or greater (NPV 81%). Both non-blinded and blinded annotations were linearly correlated and demonstrated good agreement with histology. Accurate localization of VSCC and measurements of the surgical tumor-free margins in fresh RLE specimens using ex vivo MRI seems feasible. High diagnostic performance in VSCC localization and identification of margins less than 8 mm suggest ex vivo MRI to be clinically applicable.
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Affiliation(s)
- Jan Heidkamp
- Department of Radiology and Nuclear MedicineRadboud University Medical CenterNijmegenThe Netherlands
| | - Petra L.M. Zusterzeel
- Department of Obstetrics and GynaecologyRadboud University Medical CenterNijmegenThe Netherlands
| | | | - Christiaan G. Overduin
- Department of Radiology and Nuclear MedicineRadboud University Medical CenterNijmegenThe Netherlands
| | - Andor Veltien
- Department of Radiology and Nuclear MedicineRadboud University Medical CenterNijmegenThe Netherlands
| | - Arie Maat
- Department of PathologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Maroeska M. Rovers
- Department of Operating RoomsRadboud University Medical CenterNijmegenThe Netherlands
| | - Jurgen J. Fütterer
- Department of Radiology and Nuclear MedicineRadboud University Medical CenterNijmegenThe Netherlands
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Höckel M, Trott S, Dornhöfer N, Horn LC, Hentschel B, Wolf B. Vulvar field resection based on ontogenetic cancer field theory for surgical treatment of vulvar carcinoma: a single-centre, single-group, prospective trial. Lancet Oncol 2018. [PMID: 29530664 DOI: 10.1016/s1470-2045(18)30109-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND The incidence of vulvar cancer is increasing, but surgical treatment-the current standard of care-often leads to unsatisfactory outcomes, especially in patients with node-positive disease. Preliminary results at our centre showed that locoregional spread of vulvar carcinoma occurs within tissue domains defined by stepwise embryonic and fetal development (ontogenetic cancer fields and associated lymph node regions). We propose that clinical translation of these insights into practice could improve outcomes of surgical treatment of vulvar cancer. METHODS We did a single-centre prospective trial at the University of Leipzig's Cancer Center. Eligible patients were aged 18 years or older, had ontogenetic stage 1-3b histologically proven primary carcinoma of the vulva, and had not undergone previous surgical or radiotherapy treatment for vulvar cancer or any other major perineal or pelvic disease. In view of staged morphogenesis of the vulva from the cloacal membrane endoderm at Carnegie stage 11 to adulthood, we defined the tissue domains of tumour spread according to the theory of ontogenetic cancer fields. On the basis of ontogenetic staging, patients were treated locally with partial, total, or extended vulvar field resection; regionally with therapeutic inguinopelvic lymph node dissection; and anatomical reconstruction without adjuvant radiotherapy. The primary endpoints were recurrence-free survival, disease-specific survival, and early postoperative complications. Analysis of tumour spread and early postoperative surgical complications was done by intention to treat (ie, all patients were included), whereas outcome analyses were done per protocol. This ongoing trial is registered with the German Clinical Trials Register, number DRKS00013358. FINDINGS Between March 1, 2009, and June 8, 2017, 97 consecutive patients were included in the study, of whom 94 were treated per protocol with vulvar field resection, therapeutic inguinopelvic lymph node dissection, and anatomical reconstruction without adjuvant radiotherapy. 46 patients had moderate or severe postoperative complications, especially infectious perineal and inguinal wound dehiscence. 3-year recurrence-free survival in all patients was 85·1% (95% CI 76·9-93·3), and 3-year disease-specific survival was 86·0% (78·2-93·8). INTERPRETATION Our results support the theory of ontogenetic cancer fields for vulvar carcinoma, accord with our previous findings in cervical cancer, and suggest the general applicability of the theory. Application of the concept of cancer field resection could improve outcomes in patients with vulvar carcinoma, but needs to be investigated further in multicentre randomised controlled trials. FUNDING Leipzig School of Radical Pelvic Surgery and Gynecologic Oncology Research Foundation.
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Affiliation(s)
- Michael Höckel
- Department of Gynecology, Women's and Children's Center, University of Leipzig, Leipzig, Germany; Leipzig School of Radical Pelvic Surgery, University of Leipzig, Leipzig, Germany.
| | - Sophia Trott
- Department of Gynecology, Women's and Children's Center, University of Leipzig, Leipzig, Germany
| | - Nadja Dornhöfer
- Department of Gynecology, Women's and Children's Center, University of Leipzig, Leipzig, Germany
| | - Lars-Christian Horn
- Division of Breast, Gynecological and Perinatal Pathology, Institute of Pathology, University of Leipzig, Leipzig, Germany
| | - Bettina Hentschel
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Benjamin Wolf
- Department of Gynecology, Women's and Children's Center, University of Leipzig, Leipzig, Germany
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Woo KJ, Bang SI, Mun GH, Oh KS, Pyon JK, Lim SY. Long-term outcomes of surgical treatment for dermatofibrosarcoma protuberans according to width of gross resection margin. J Plast Reconstr Aesthet Surg 2016; 69:395-401. [DOI: 10.1016/j.bjps.2015.10.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 10/19/2015] [Indexed: 11/28/2022]
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Khanna N, Rauh LA, Lachiewicz MP, Horowitz IR. Margins for cervical and vulvar cancer. J Surg Oncol 2016; 113:304-9. [PMID: 26852901 DOI: 10.1002/jso.24108] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 11/14/2015] [Indexed: 11/07/2022]
Abstract
Surgery is the primary treatment for vulvar cancer as well as early-stage carcinoma of the cervix. This article reviews the significance of margin status after surgery on overall survival, need for further surgical intervention, and role for possible adjuvant therapy. It summarizes the abundant literature on margin status in vulvar cancer and highlights the need for further investigation on the prognostic significance of margins in cervical cancer. In addition, it reviews other important operative considerations.
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Affiliation(s)
- Namita Khanna
- Division of Gynecologic Oncology, Winship Cancer Institute, Atlanta, Georgia.,Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Lisa A Rauh
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Mark P Lachiewicz
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Ira R Horowitz
- Division of Gynecologic Oncology, Winship Cancer Institute, Atlanta, Georgia.,Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
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Frozen section in gynaecology: uses and limitations. Arch Gynecol Obstet 2014; 289:1165-70. [DOI: 10.1007/s00404-013-3135-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 12/16/2013] [Indexed: 01/04/2023]
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Lax S, Tamussino K, Prein K, Lang P. Schnellschnittdiagnostik bei Erkrankungen des weiblichen Genitaltrakts. DER PATHOLOGE 2012; 33:430-40. [DOI: 10.1007/s00292-012-1597-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
PURPOSE OF REVIEW The purpose of this review is to outline current controversies in management of early-stage vulvar cancer. The main focus will be on the procedures for assessing the sentinel node and the treatment of those with evidence of metastatic involvement. RECENT FINDINGS Assessment of the sentinel node has recently been introduced into the standard treatment of early-stage squamous cell vulvar cancer. The combination of a radioactive tracer and blue dye is the most accurate technique for sentinel node detection. Preoperative imaging is recommended to rule out gross nodal involvement and ultrasound with fine needle aspiration cytology by an experienced radiologist appears to have the highest sensitivity/specificity for detecting metastases, although large comparative studies are not available. All patients with sentinel node metastases require additional treatment to the groin, independent of the size of metastasis in the sentinel node and currently this involves inguinofemoral lymphadenectomy. Further research is ongoing to investigate the role of radiotherapy instead of lymphadenectomy. The little experience there is of sentinel node biopsy in vulvar melanoma suggests that the procedure is feasible and inclusion criteria should follow those of cutaneous melanoma. SUMMARY Sentinel node biopsy is safe in treatment of early-stage vulvar cancer. Ongoing studies are investigating the optimal additional treatment for patients with a positive sentinel node in terms of efficacy and morbidity.
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Vulvar field resection: Novel approach to the surgical treatment of vulvar cancer based on ontogenetic anatomy. Gynecol Oncol 2010; 119:106-13. [DOI: 10.1016/j.ygyno.2010.06.019] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 06/18/2010] [Accepted: 06/19/2010] [Indexed: 11/21/2022]
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