Cisplatin (P), bleomycin (B), and methotrexate (M) preoperative chemotherapy in locally advanced vulvar carcinoma

Based on the encouraging results of neoadjuvant chemotherapy (NACT) and radical surgery (RS) observed in locally advanced cervical cancer, 21 patients with advanced squamous cell carcinoma of the vulva (FIGO stages, IVa, 21; TNM stages, T2N2M0, 6, T3N2M0, 11, T4N2M0, 4) were submitted to two to three cycles of cisplatin (P, 100 mg/m2, Day 1), bleomycin (B, 15 mg, Days 1, 8), and methotrexate (M, 300 mg/m2 + cfr, Day 8) NACT followed by RS in operable patients. Two patients (10%) had a partial response in the primary tumor (T) and 14 (67% CR+PR) in the inguinal nodes (N). The operability rate following NACT was 90% (pathological downstaging rate, 33%) but surgery was really radical in 79% of cases. Pathological N response was significantly related to the pathological T downstaging, and a persistently high N positivity rate was detected (inguinal, 81%; pelvic, 47%). NACT+RS had an acceptable morbidity but the therapeutic results were less encouraging than expected with a 3-year survival of 24% and stage, pathological T downstaging, and N status all significantly affected survival. Sixty-eight percent of the operated patients recurred 3-17 months from the end of treatment and 50% of them had a distant relapse. PBM NACT did not seem to add any substantial benefit to the surgery alone in this subset of patients with extremely advanced disease. Studies on a chemoradiotherapeutic approach are currently in progress in order to confirm the promising preliminary results.