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Published on: September 12, 2019
Radiation therapy compared with pelvic node resection for node-positive vulvar cancer: a randomized controlled trial.
Charles Kunos1, Fiona Simpkins, Heidi Gibbons
1From the Department of Radiation Oncology, University Hospitals of Cleveland, Cleveland, Ohio; the Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Cleveland Clinic Foundation, Cleveland, Ohio; the Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University Hospitals of Cleveland, Cleveland, Ohio; the Gynecologic Oncology Group Statistical and Data Center; Roswell Park Cancer Institute, Buffalo, New York; and the Gynecologic Oncology Network/Brody School of Medicine, Greenville, North Carolina. Fiona Simpkins, MD, is currently at the Miller School of Medicine, University of Miami, Miami, Florida.
Radiation therapy after vulvar cancer surgery significantly lowers local relapses and cancer deaths compared to pelvic node resection. Long-term toxicities were similar between the two treatment groups for vulvar cancer patients.
Area of Science:
- Gynecologic Oncology
- Radiation Oncology
- Surgical Oncology
Background:
- Vulvar cancer with positive groin lymph nodes presents a treatment challenge.
- Optimal management of groin node-positive vulvar cancer requires careful consideration of local control and toxicity.
- Pelvic node resection and radiation therapy are potential treatment options for these patients.
Purpose of the Study:
- To compare long-term survival and toxicity outcomes of radiation therapy versus pelvic node resection in patients with groin node-positive vulvar cancer.
- To evaluate the impact of these treatments on disease progression and cancer-related mortality.
Main Methods:
- A randomized trial enrolled 114 patients with groin node-positive vulvar cancer after radical vulvectomy and inguinal lymphadenectomy.
- Patients were allocated to either postoperative pelvic and groin radiation (45-50 Gy) or ipsilateral pelvic node resection.
- Retrospective analysis assessed risk of progression, death, and treatment toxicity.
Main Results:
- Radiation therapy was associated with a 39% lower risk of progression.
- While overall survival showed a trend favoring radiation, cancer-related death rates were significantly lower with radiation (29% vs. 51% at 6 years).
- Late toxicities, including lymphedema and desquamation, were comparable between the radiation and pelvic node resection groups.
Conclusions:
- Postoperative radiation therapy significantly reduces local relapses in groin node-positive vulvar cancer.
- Radiation therapy decreases cancer-related deaths compared to pelvic node resection.
- Long-term toxicities are similar between radiation and pelvic node resection, making radiation a favorable option for selected patients.
