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The Effect of Groin Treatment Modality and Sequence on Clinically Significant Chronic Lymphedema in Patients With Vulvar Carcinoma
  1. Jessica Berger, MD*,
  2. Eirwen Scott, MD,
  3. Paniti Sukumvanich, MD*,
  4. Ashlee Smith, DO*,
  5. Alexander Olawaiye, MD*,
  6. John Comerci, MD*,
  7. Joseph L. Kelley, MD*,
  8. Sushil Beriwal, MD and
  9. Marilyn Huang, MD, MS*
  1. *Division of Gynecologic Oncology,
  2. Department of Obstetrics, Gynecology, and Reproductive Sciences, and
  3. Department of Radiation Oncology, Magee Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA.
  1. Address correspondence and reprint requests to Jessica Berger, MD, Division of Gynecologic Oncology, Magee Womens Hospital of the University of Pittsburgh Medical Center, 300 Halket St, Pittsburgh, PA 15213. E-mail: bergerjl{at}


Objective Chronic lymphedema (CL) after inguinal lymph node dissection (ILND) or radiotherapy (RT) is a significant problem for vulvar cancer survivors. The treatment modality or combination of therapies that poses the greatest risk is not known. The objective of this study was to describe rates of clinically significant CL conferred by different groin treatment modalities.

Methods Medical records of vulvar cancer patients who had groin treatment with ILND, RT, or both were retrospectively reviewed. Each treated groin was considered individually, and divided into 4 treatment groups: ILND alone, ILND with adjuvant RT, neoadjuvant chemoradiation therapy (NCRT), or NCRT followed by ILND. Clinically significant CL was defined as that which required treatment and was recorded by laterality. Differences among groups were evaluated with χ2 and Fisher exact test.

Results Between 2000 and 2010, 146 patients with vulvar cancer who underwent therapy to 1 or both groins were identified for a total of 266 treated groins. The rates of CL for single-modality treatment, ILND or NCRT, were 10.9% and 6.7%, respectively. Multimodal treatment resulted in higher rates of CL, 13.5% for ILND followed by RT and 17.2% for NCRT followed by ILND, although differences were not significant (P = 0.37).

Conclusions Clinically significant CL was not different between treatment modalities in this study, but is underpowered. The results provide valuable information about treatment complications that will be useful for patient-centered counseling. Prospective evaluation of CL and its impact on quality of life is warranted.

  • Lymphedema
  • Vulvar carcinoma
  • Lymphadenectomy
  • Radiotherapy

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  • The authors declare no conflicts of interest.

  • Ashlee Smith is now with the Division of Gynecologic Oncology, Geisinger Medical Center, Danville, PA.