443 High-dose density neoadjuvant chemotherapy before radical surgery in advanced vulvar cancer

Abstract

Objectives Mortality is high in advanced vulvar cancer and treatment associate with several adverse events. Neoadjuvant chemotherapy (NAC) administered before surgery is successful in patients with bulky squamous cervical cancer. We used NAC in 10 women with advanced squamous cell vulvar cancer. Methods Women with advanced vulvar cancer (bulky nodes and/or T3 tumors) were included in prospective study. Combination chemotherapy (cisplatin 75 mg/m2and ifosfamide 2 g/m2) was given in 10-day intervals. Radical surgery was performed after chemotherapy. Results Ten women were included into study (six with bulky nodes, two with T3 tumors and two with combination of bulky nodes and T3 tumors). Hematological toxicity (grade 3–4) occurred in two patients after chemotherapy. Radical vulvectomy with inguinofemoral lymphadenectomy was performed in nine patients, posterior exenteration in one. Response of more than 50% was found in eight patients (one complete); we did not observe any response in two patients. Six patients underwent adjuvant radiotherapy, two had adjuvant chemotherapy and two were not administered adjuvant treatment. Two patients had recurrence (both with no response to chemotherapy) and died of disease. Six patients are alive without evidence of disease and two died of internal disease without evidence of disease. Conclusions Response rate for NAC in squamous cell vulvar cancer was 80% while the recurrence rate was only 20% in such an unfavorable group of patients. High-dose density NAC seems to be a viable option to neoadjuvant radiotherapy in advanced vulvar cancer with lower morbidity. This work was supported by the Charles University research program PROGRES Q 28 (Oncology).