Management of inguinal lymph nodes in locally advanced, surgically unresectable, squamous cell carcinoma of the vulva

Brenna E Swift; Lama Khoja; Joanna Matthews; Jennifer Croke; Stephane Laframboise; Eric Leung; Lilian T Gien

doi:10.1016/j.ygyno.2024.04.025

Management of inguinal lymph nodes in locally advanced, surgically unresectable, squamous cell carcinoma of the vulva

Gynecol Oncol. 2024 May 8:187:46-50. doi: 10.1016/j.ygyno.2024.04.025. Online ahead of print.

Authors

Brenna E Swift¹, Lama Khoja², Joanna Matthews³, Jennifer Croke⁴, Stephane Laframboise⁵, Eric Leung⁶, Lilian T Gien⁷

Affiliations

¹ Department of Obstetrics and Gynaecology, Division of Gynecologic Oncology, University of Toronto, Toronto, ON, Canada; Department of Obstetrics and Gynaecology, Division of Gynecologic Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
² Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.
³ Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
⁴ Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
⁵ Department of Obstetrics and Gynaecology, Division of Gynecologic Oncology, University of Toronto, Toronto, ON, Canada; Department of Surgical Oncology, Division of Gynecologic Oncology, University Health Network, Toronto, ON, Canada.
⁶ Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
⁷ Department of Obstetrics and Gynaecology, Division of Gynecologic Oncology, University of Toronto, Toronto, ON, Canada; Department of Obstetrics and Gynaecology, Division of Gynecologic Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. Electronic address: lilian.gien@sunnybrook.ca.

PMID: 38723339
DOI: 10.1016/j.ygyno.2024.04.025

Abstract

Objective: To assess clinical outcomes of inguinal lymph node surgical resection compared to primary groin radiotherapy for locally advanced, surgically unresectable vulvar cancer.

Methods: All patients treated with radiation for vulvar cancer were identified between Jan 1, 2000 - Dec 31, 2020 at 2 academic centres. Inclusion criteria were those treated with curative intent primary radiotherapy +/- chemotherapy, tumors >4 cm, and surgically unresectable squamous cell vulvar carcinoma. Groin recurrence-free survival (RFS) was compared for groin surgery and primary groin radiotherapy using the Kaplan Meier method and log rank test. Groin failures are described by treatment modality, radiation dose and lymph node size.

Results: Of 476 patients treated with radiation for vulvar cancer, 112 patients (23.5%) met inclusion and exclusion criteria. The median (95% CI) follow up was 1.9 (1.4-2.5) years. Complete clinical response was significantly higher (80.0%) in patients with surgical groin resection compared to patients treated with primary groin radiotherapy (58.2%) (p = 0.04). On multivariable analysis, after adjusting for clinical and/or radiologically abnormal lymph nodes (p = 0.67), surgical groin resection was significantly associated with lower groin recurrence (HR 0.2 (95%CI 0.05-0.92), p = 0.04). The 3-year groin recurrence-free survival (RFS) was significantly higher at 94.4% (87.1-100) in patients with surgical groin resection compared to 79.2% (69.1-90.9) in patients treated with primary radiation (p = 0.02).

Conclusions: In locally advanced squamous cell vulvar cancer, surgical groin management improves groin RFS compared to radiotherapy alone.

Keywords: Groin radiation; Groin recurrence free survival; Inguinofemoral lymphadenectomy; Lymph node; Vulva cancer.