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Published on: September 12, 2019
Neoadjuvant chemoradiation for advanced primary vulvar cancer
H C van Doorn1, A Ansink, M Verhaar-Langereis
1Erasmus Medical Center, Department of Gynaecological Oncology, Dr. Molewaterplein 40, 3015 GD Rotterdam, Netherlands. h.vandoorn@erasmusmc.nl
The Cochrane Database of Systematic Reviews
|July 21, 2006
Summary
Neoadjuvant chemoradiation therapy improves operability in advanced vulvar cancer but has considerable complications. It benefits patients with inoperable tumors but may not be justified for those treatable with surgery alone.
Area of Science:
- Gynecologic Oncology
- Radiation Oncology
- Medical Oncology
Background:
- Advanced primary vulvar cancer requires tailored treatment strategies.
- Combined treatment modalities including chemotherapy, radiotherapy, and surgery are utilized.
Purpose of the Study:
- To evaluate the effectiveness and safety of neoadjuvant chemoradiation therapy followed by surgery for advanced vulvar cancer.
- To assess surgical interventions, survival rates, recurrence, and complication rates.
Main Methods:
- A systematic review of studies on curative treatment for advanced primary squamous cell carcinoma of the vulva.
- Inclusion criteria required concurrent radiotherapy and chemotherapy followed by surgery.
- Five studies met the criteria; no randomized controlled trials were available.
Main Results:
- Neoadjuvant chemoradiotherapy reduced tumor size and improved operability in most cases (63-92%) with specific chemotherapy regimens.
- Nearly all patients experienced skin toxicity, and wound complications were common.
- Survival rates varied (26-63% alive and well), with significant treatment-related mortality (27-85%).
Conclusions:
- Chemoradiation benefits patients with inoperable primary tumors or lymph nodes, enabling surgery.
- For tumors requiring extensive surgery (exenteration), neoadjuvant therapy complications may outweigh surgical risks.
- Neoadjuvant therapy is not recommended for tumors amenable to radical vulvectomy and lymph node dissection alone.
