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Vaginal and vulvar cancer
2022-RA-1268-ESGO Surgery after primary chemo/radiation in locally advanced vulvar cancer: analysis of surgical outcomes and survival
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  1. Simona Maria Fragomeni1,
  2. Alex Federico1,
  3. Valentina Lancellotta2,
  4. Luca Tagliaferri2,
  5. Sonia Bove3,
  6. Anna Amelia Caretto4,
  7. Stefano Gentileschi5,
  8. Giacomo Corrado1,
  9. Giovanni Scambia6 and
  10. Giorgia Garganese6
  1. 1UOC Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
  2. 2UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
  3. 3Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
  4. 4Università Cattolica del Sacro Cuore, Rome, Italy
  5. 5Istituto di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
  6. 6Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Sezione di Ginecologia ed Ostetricia, Rome, Italy

Abstract

Introduction/Background More than 30% of vulvar cancer new cases are locally advanced (LAVC). The treatment of LAVC consists of primary radiotherapy, +/- chemotherapy – (CT)RT. Surgery is scheduled after neoadjuvant treatment or added to exclusive (CT)RT to debulk residual disease. Our aim was to assess survival and surgical complications in this setting.

Methodology Patients with squamous LAVC submitted to (CT)RT and surgery at our Institution between January 2016 and December 2021 were retrospectively evaluated.

Results 51 patients were submitted to primary (CT)RT: 40 (78,4%) had a clinical response (complete in 18 and partial in 22 cases), 1 (2%) stable and 10 (19.6%) progression disease. Overall, 19/51 (37.2%) patients underwent surgery.Regarding baseline nodal involvement of surgically treated patients, the work up showed 6 (31,6%) clinically negative, 3 (15,8%) clinically positive inguinal nodes and 10 (52,6%) pelvic nodal disease. Surgeries were classified as radical [vulvar and/or inguinal surgery, n=5 (26.3%)] and ultra-radical [requiring plastic reconstruction and/or pelvic surgery (visceral or lymph-nodal), n=14 (73.7%)]. Overall, 17 patients (89,4%) experienced a post operative complication with a Clavien-Dindo grade ≤2 in 58,8% of cases (17,6% after radical and 41,2% after ultra-radical surgery) (Table 1).Five (26.3%) patients showed pathological complete response (pCR), while 14 (73.7%) had residual tumor [7 (36.8%) vulvar-site, 1 (5.3%) LN-site and both-sites in 6 (31.6%) cases].The 3-years disease-free survival was 100% in case of pCR and 30.8% for residual tumor, (p=0.036) (Figure 1).

Abstract 2022-RA-1268-ESGO Figure 1
Abstract 2022-RA-1268-ESGO Figure 1
View this table:
Abstract 2022-RA-1268-ESGO Table 1

Conclusion A high rate of clinical responses (complete/partial) to (CT)RT was registered. Post-operative complications resulted acceptable compared to literature data. pCR is associated with excellent survival also in these tumors as demonstrated in other neoplasms. The multidisciplinary approach is crucial to complete the combined treatment planned [(CT)RT+/- surgery]. In the future, predictive models could allow to select patients on the basis of their foreseen response.

https://doi.org/10.1136/ijgc-2022-ESGO.959

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