History and Updates of the GROINSS-V Studies

Area of Science:

• Gynecologic Oncology
• Surgical Oncology
• Radiation Oncology

Background:

• Vulvar cancer treatment, particularly surgical management, carries significant morbidity.
• The GROINSS-V studies aim to reduce treatment-related complications in early-stage vulvar cancer.
• Sentinel lymph node biopsy (SLNB) is a key diagnostic tool.

Purpose of the Study:

• To review the history, results, and updates of the GROINSS-V studies.
• To evaluate the safety and efficacy of SLNB and alternative treatments for early-stage vulvar cancer.
• To inform clinical guidelines for vulvar cancer management.

Main Methods:

• GROINSS-V-I: Multicenter observational study evaluating SLNB safety and applicability.
• GROINSS-V-II: Prospective multicenter phase II trial assessing radiotherapy for metastatic sentinel lymph nodes (micrometastases).
• GROINSS-V-III: Ongoing trial investigating chemoradiation for macrometastases in sentinel lymph nodes.

Main Results:

• GROINSS-V-I: Omitting inguinofemoral lymphadenectomy in early-stage vulvar cancer with negative SLNB is safe, significantly reducing morbidity.
• GROINSS-V-II: Radiotherapy for sentinel lymph node micrometastases (≤2 mm) is safe, with low groin recurrence rates and reduced morbidity compared to surgery.
• Published results of GROINSS-V-II (August 2021) support guideline implementation.

Conclusions:

• Sentinel lymph node biopsy is a safe and effective alternative to inguinofemoral lymphadenectomy for early-stage vulvar cancer.
• Radiotherapy is a viable, less morbid option for managing sentinel lymph node micrometastases in vulvar cancer.
• Ongoing research (GROINSS-V-III) continues to explore optimal treatment strategies for advanced nodal disease.