Neoadjuvant chemotherapy in vulvar cancer: avoiding primary exenteration

Area of Science:

• Gynecologic Oncology
• Medical Oncology
• Surgical Oncology

Background:

• Advanced vulvar cancer involving the anal sphincter and/or urethra presents a surgical challenge.
• Primary pelvic exenteration is often required, leading to significant morbidity.
• Neoadjuvant chemotherapy offers a potential strategy to preserve these critical pelvic structures.

Purpose of the Study:

• To evaluate the efficacy of neoadjuvant cisplatin and 5-fluorouracil chemotherapy in preserving the anal sphincter and/or urethra in advanced vulvar cancer.
• To assess the response rate and oncologic outcomes following this neoadjuvant approach.

Main Methods:

• Fourteen patients with advanced vulvar cancer underwent 3-4 cycles of neoadjuvant chemotherapy (cisplatin and 5-fluorouracil or cisplatin alone).
• Surgical intervention (radical vulvectomy and groin lymph node dissection) was planned post-chemotherapy.
• Lesion size was documented pre- and post-chemotherapy.

Main Results:

• All patients receiving cisplatin and 5-fluorouracil showed at least a partial response, with a 100% response rate.
• The anal sphincter and urethra were conserved in all patients treated with cisplatin and 5-fluorouracil.
• Patients receiving cisplatin and 5-fluorouracil followed by surgery were disease-free at the time of reporting.

Conclusions:

• Neoadjuvant cisplatin and 5-fluorouracil is highly effective in advanced vulvar cancer involving the anal sphincter and/or urethra.
• This regimen enables sphincter and urethral preservation, avoiding the morbidity of exenteration.
• The combination demonstrates superior activity and warrants consideration in managing such cases.