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Tailoring the Treatment of Locally Advanced Squamous Cell Carcinoma of the Vulva: Neoadjuvant Chemotherapy Followed by Radical Surgery
  1. Alejandro M. Aragona, MD*,,
  2. Nicasio Cuneo, MD*,
  3. Alejandro H. Soderini, MD*,
  4. Elsa Alcoba, MD,
  5. Adriana Greco, MD§,
  6. Carlos Reyes, MD and
  7. Silvia Lekmann, MD
  1. *Department of Gynecologic Oncology, Oncologic Hospital of Buenos Aires Marie Curie;
  2. University of Buenos Aires (UBA);
  3. Division of Anatomic Pathology, Department of Gynecologic Oncology, Oncologic Hospital of Buenos Aires Marie Curie;
  4. §Division of Gynecology, Parmenio Piñero Hospital; and
  5. ||Unit of Gynecologic Oncology, Division of Gynecology, Parmenio Piñero Hospital, Buenos Aires, Argentina.
  1. Address correspondence and reprint requests to Alejandro M. Aragona, MD, Department of Gynecologic Oncology, Oncologic Hospital of Buenos Aires Marie Curie; and University of Buenos Aires (UBA), Patricias Argentinas 750, 1405 Capital Federal, Buenos Aires, Argentina. E-mail: alearagona2{at}gmail.com.

Abstract

Objective To determine the feasibility of performing neoadjuvant chemotherapy (NCH) followed by radical surgery in patients with locally advanced squamous cell carcinoma of the vulva.

Methods Prospective and multicenter trial. Thirty-five patients with a diagnosis of previously untreated locally advanced squamous cell carcinoma of the vulva were given 4 schemes of cisplatin-based NCH and 1 NCH regimen with single bleomycin. Then, they underwent radical surgery of the vulva if clinical response was 50% or more. Age, NCH schemes used, toxicity, response to treatment, type of radical surgery performed, and clinical outcome were evaluated.

Results Thirty-three patients completed the proposed schemes, and 30 were assessed for radical surgery. Finally, 27 patients underwent radical surgery (radical vulvectomy or radical local excision plus bilateral inguinofemoral lymphadenectomy). In 2 cases of persistent rectal involvement, posterior pelvic exenteration was performed. Moreover, 24 of 27 patients remain with no evidence of disease to date. Toxicity was acceptable. Median age was 62 years (range, 54–72 years). Median follow-up was 49 months (range, 4–155 months).

Conclusions The use of NCH in selected groups may increase surgical feasibility in initially inoperable patients, thus favoring organ preservation and less extensive resections. Adverse reactions were acceptable, and vulvoperineal deleterious effects that may occur after radiotherapy were consequently avoided.

  • Vulvar cancer
  • Radical surgery
  • Neoadjuvant chemotherapy

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Footnotes

  • The authors declare no conflicts of interest.

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