Abstract
ObjectiveMost guidelines advise no adjuvant radiotherapy in vulvar squamous cell carcinoma and a single occult intracapsular lymph node metastasis. However, several recent studies have questioned the validity of this recommendation. The aim of this study was to analyze the groin recurrence rate in patients with a single intracapsular positive lymph node treated without adjuvant radiotherapy. MethodsPatients with a single clinically occult intracapsular lymph node metastasis, treated without adjuvant radiotherapy, formed the basis for this study. Groin recurrences, and the risk of death, were analyzed in relation to the size of the metastasis in the lymph node and the lymph node ratio. Data were analyzed using SPSS, version 26.0 for Windows. ResultsAfter a median follow-up of 64 months, one of 96 patients (1%) was diagnosed with an isolated groin recurrence and another two (2.1%) were diagnosed with a combination of a local and a groin recurrence. The only isolated groin recurrence occurred in a contralateral lymph node negative groin. Size of the metastasis and lymph node ratio had no impact on the groin recurrence risk, nor on survival. The 5-year actuarial disease-specific and overall survivals were 79% and 62.5% respectively. The 5-year actuarial groin recurrence-free survival was 97%. ConclusionBecause of the low risk of groin recurrence and the excellent groin recurrence-free survival, we recommend that adjuvant radiotherapy to the groin in patients with vulvar squamous cell carcinoma and a single occult intracapsular lymph node metastasis can be safely omitted to prevent unnecessary toxicity and morbidity.
Highlights
Vulvar cancer is a rare disease and mainly affects older women
Stage T1A tumors with a diameter 2 cm or less and a depth of invasion 1 mm or less have a negligible risk of lymph node metastases [3]
Standard treatment for all other squamous cell cancers (SCC) of the vulva consists of a radical local excision of the primary tumor and either lymph node evaluation by sentinel lymph node (SLN) biopsy or primary inguinal femoral lymphadenectomy (IFL) [4]
Summary
Vulvar cancer is a rare disease and mainly affects older women. A steep increase is seen in the yearly incidence in the Netherlands, from 1-2/100.000 in women aged 50 to 60 years to 14 per 100.000 in⁎ Corresponding author at: Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.women over 80 years [1]. A steep increase is seen in the yearly incidence in the Netherlands, from 1-2/100.000 in women aged 50 to 60 years to 14 per 100.000 in. Regional metastases in the inguinal femoral lymph nodes occur frequently and are related to pathological variables such as depth of invasion, lymph vascular space invasion and tumor size [2]. Standard treatment for all other squamous cell cancers (SCC) of the vulva consists of a radical local excision of the primary tumor and either lymph node evaluation by sentinel lymph node (SLN) biopsy or primary inguinal femoral lymphadenectomy (IFL) [4]. In a subgroup analysis of this study, patients with a single clinically occult positive lymph node displayed no benefit from radiotherapy. A subsequent study from our institution confirmed that patients with a single clinically occult intracapsular lymph node metastasis had a low risk of groin recurrence [6]
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