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2022-RA-690-ESGO Unilateral inguinofemoral lymphadenectomy in patients with early-stage vulvar squamous cell carcinoma and a unilateral metastatic sentinel lymph node is safe
  1. Willemijn L van der Kolk1,
  2. Ate GJ van der Zee1,
  3. Brian Slomovitz2,
  4. Peter JW Baldwin3,
  5. Helena C van Doorn4,
  6. Joanne A de Hullu5,
  7. Jacobus van der Velden6,
  8. Katja N Gaarenstroom7,
  9. Brigitte FM Slangen8,
  10. Preben Kjølhede9,
  11. Mats Brännström10,
  12. Ignace Vergrote11,
  13. Cathrine M Holland12,
  14. Robert Coleman13,
  15. Eleonora BL van Dorst14,
  16. Willemien J van Driel15,
  17. David Nunns16,
  18. Martin Widschwendter17,
  19. David Nugent18,
  20. Paul A DiSilvestro19,
  21. Robert S Mannel20,
  22. Ming Y Tjiong6,
  23. Dorry Boll21,
  24. David Cibula22,
  25. Al Covens23,
  26. Diane Provencher24,
  27. Ingo B Runnebaum25,
  28. Bradley J Monk26,
  29. Vanna Zanagnolo27,
  30. Karl Tamussino28,
  31. Maaike HM Oonk1,
  32. GROINSS-V I and II participants
  1. 1University Medical Center Groningen, Groningen, Netherlands
  2. 2Mount Sinai Medical Center, Miami Beach, FL
  3. 3Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  4. 4Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
  5. 5Radboud University Medical Center, Nijmegen, Netherlands
  6. 6Amsterdam University Medical Center, Amsterdam, Netherlands
  7. 7Leiden University Medical Center, Leiden, Netherlands
  8. 8Maastricht University Medical Center+, Maastricht, Netherlands
  9. 9Linköping University, Linköping, Sweden
  10. 10Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
  11. 11Leuven Cancer Institute, Leuven, Belgium
  12. 12Manchester University NHS Foundation Trust-St Marys Hospital, Manchester, UK
  13. 13The University of Texas MD Anderson Cancer Center, Houston, TX
  14. 14University Medical Center Utrecht, Utrecht, Netherlands
  15. 15Center of Gynecological Oncology Amsterdam, The Netherlands Cancer Institute, Amsterdam, Netherlands
  16. 16Nottingham University Hospitals NHS Trust, Nottingham, UK
  17. 17European Translational Oncology Prevention and Screening (EUTOPS) Institute, University Innsbruck, Innsbruck, Austria
  18. 18Leeds Teaching Hospitals NHS Trust, St James’ University Hospital, Leeds, UK
  19. 19Women and Infants Hospital of Rhode Island, Providence, RI
  20. 20Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK
  21. 21Catharina Ziekenhuis Eindhoven, Eindhoven, Netherlands
  22. 22First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
  23. 23University of Toronto, Toronto, ON, Canada
  24. 24CHUM, Université de Montréal, Montréal, QC, Canada
  25. 25Jena University Hospital, Friedrich Schiller University, Jena, Germany
  26. 26St Josephs Hospital and Medical Center, Phoenix, AZ
  27. 27European Cancer Institute, Milan, Italy
  28. 28Medical University Graz, Graz, Austria


Introduction/Background Optimal management of the contralateral groin in patients with early-stage vulvar squamous cell carcinoma (VSCC) and a metastatic unilateral inguinal sentinel lymph node (SN) is unclear. We analyzed patients who participated in GROningen INternational Study on Sentinel nodes in Vulvar cancer (GROINSS-V) I or II to determine whether treatment of the contralateral groin can safely be omitted in patients with a unilateral metastatic SN.

Methodology We selected the patients with a unilateral metastatic SN from the GROINSS-V I and II databases. We determined the incidence of contralateral additional non-SN metastases in patients with unilateral SN-metastasis who underwent bilateral inguinofemoral lymphadenectomy (IFL). In those who underwent only ipsilateral groin treatment or no further treatment, we determined the incidence of contralateral groin recurrences during follow-up.

Results Of 1912 patients with early-stage VSCC, 366 had a unilateral metastatic SN. Subsequently, 244 had an IFL or no treatment of the contralateral groin. In eight patients (8/244; 3.3% [95% CI: 1.7%-6.3%]) disease was diagnosed in the contralateral groin: six had contralateral non-SN metastasis at IFL and two developed an isolated contralateral groin recurrence after nu further treatment. Six of them had a primary tumor ≥30 mm. Bilateral radiotherapy was administered in 122 patients, of whom one (1/122; 0.8% [95% CI: 0.1%-4.5%]) had a contralateral groin recurrence.

Conclusion The risk of contralateral lymph node metastases in patients with early-stage VSCC and a unilateral metastatic SN is low. It appears safe to limit groin treatment to unilateral IFL or inguinofemoral radiotherapy in these cases, particularly if the primary tumor is <30 mm.

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