Groin dissection versus groin radiation in carcinoma of the vulva: A gynecologic oncology group study

Abstract

Purpose: The objective of this study was to determine if groin radiation was superior to and less morbid than groin dissection. Methods and Materials: Members of the Gynecologic Oncology Group randomized 58 patients with squamous carcinoma of the vulva and nonsuspicious (N 0–1) inguinal nodes to receive either groin dissection or groin radiation, each in conjunction with radical vulvectomy. 3|'Radiation therapy consisted of a dose of 50 Gray given in daily 200 centiGray fractions to a depth of 3 cm below the anterior skin surface. Results: The study was closed prematurely when interim monitoring revealed an excessive number of groin relapses on the groin radiation regimen. Metastatic involvement of the groin nodes was projected to occur in 24% of patients based on this Group's previous experience. On the groin dissection regimen, there were 5 25 (20.0%) patients with positive groin nodes. These patients received post-operative radiation. There were five groin relapses among the 27 (18.5%) patients on the groin radiation regimen and none on the groin dissection regimen. The groin dissection regimen had significantly better progression-free interval ( p = 0.03) and survival ( p = 0.04). Conclusion: Radiation of the intact groins as given in this study is significantly inferior to groin dissection in patients with squamous carcinoma of the vulva and (N 0–1) nodes.