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Multidisciplinary personalized approach in the management of vulvar cancer – the Vul.Can Team experience
  1. Luca Tagliaferri1,
  2. Giorgia Garganese2,
  3. Andrea D'Aviero3,
  4. Valentina Lancellotta1,
  5. Simona Maria Fragomeni2,
  6. Bruno Fionda1,
  7. Calogero Casà3,
  8. Benedetta Gui4,
  9. Germano Perotti5,
  10. Stefano Gentileschi6,
  11. Frediano Inzani7,
  12. Giacomo Corrado2,
  13. Milly Buwenge8,
  14. Alessio Giuseppe Morganti8,
  15. Vincenzo Valentini1,3,
  16. Giovanni Scambia2,3,
  17. Maria Antonietta Gambacorta1,3 and
  18. Gabriella Macchia9
  1. 1 Unità Operativa Complessa di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Lazio, Italy
  2. 2 Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Lazio, Italy
  3. 3 Università Cattolica del Sacro Cuore, Roma, Lazio, Italy
  4. 4 Unità Operativa Complessa di Radiologia Diagnostica e Interventistica Generale, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Lazio, Italy
  5. 5 Unità Operativa Complessa di Medicina Nucleare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Lazio, Italy
  6. 6 Unità Operativa Complessa di Chirurgia Plastica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Lazio, Italy
  7. 7 Unità Operativa Semplice di Gineco-patologia e Patologia Mammaria, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Lazio, Italy
  8. 8 Department of Experimental, Diagnostic and Specialty Medicine – DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Emilia Romagna, Italy
  9. 9 Unità Operativa di Radioterapia, Gemelli Molise Hospital, Campobasso, Molise, Italy
  1. Correspondence to Dr Andrea D'Aviero, Università Cattolica del Sacro Cuore Sede di Roma, Roma 00168, Italy; andreadav89{at}gmail.com

Abstract

Introduction Multidisciplinary treatment strategy involving adjuvant radiotherapy for advanced vulvar cancer could be useful in offering the best personalized clinical approach. In 2013, the VULvar CANcer Multi-Disciplinary Team (Vul.Can MDT) was set up in our institution, in order to share knowledge and expertise, high-quality diagnosis, and evidence-based decision making in the context of personalized medicine. The aim of this observational study was to report on our series of vulvar cancer patients managed postoperatively with radiotherapy within the framework of a formal multidisciplinary tumor board.

Methods Coupling surgical and oncological international guidelines with “case-by-case” discussions, a multi-specialist consensus was progressively reached and internal recommendations were developed and introduced in the daily routine. Data from vulvar cancer patients who underwent primary surgery and adjuvant radiotherapy throughout a 5-year period were retrospectively collected. Actuarial local control was the primary endpoint, while secondary end-points were acute and late toxicities, disease-free survival, and overall survival. Toxicity was evaluated according to the Common Toxicity Criteria Adverse Event v 4.0 scale.

Results The analysis included 35 patients with squamous vulvar cancer treated with adjuvant radiotherapy±chemotherapy, from April 2013 to September 2017. Median age was 70 years (range 18–87), all patients underwent surgery followed by concomitant chemoradiation (45.7%) or radiotherapy alone (54.3%). The median prophylactic dose on lymphatic drainage was 45 Gy, while positive nodes and perineal area received 51.2 Gy and 52.6 Gy, respectively. Chemotherapy involved the cisplatin-based regimen (45.7%)±5-fluorouracil (37.1%). Median follow-up was 32 months (range 6–72): the 24-months local control, disease-free survival, and actuarial overall survival rates were 88.6%, 82.0%, and 91.0%, respectively. Low rates of severe acute (12%) and late (3%) toxicities occurred.

Discussion The outcomes of this series support the benefit of a multidisciplinary personalized approach in the management of vulvar cancer.

  • vulvar and vaginal cancer
  • radiation oncology
  • radiotherapy
  • surgical oncology
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Footnotes

  • Contributors Conception and design: LT, GG, GM. Data collection: AD’A, CC, SMF. Analysis and interpretation of data: VL, MB, BF. Manuscript writing: LT, GM, AD’A. Final manuscript approval: LT, GG, BG, GP, SG, FI, GC, AGM, VV, GS, MAG, GM.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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