[Elderly patients with vulvar carcinoma: should we use standard treatment?]

Invasive squamous cell cancer of the vulva is predominantly a disease of older women. Current standard treatment entails a radical local excision with bilateral groin node dissection through separate incisions. In individual patients with superficially invasive small tumors the groin dissection can be omitted and in patients with well lateralized tumors a contralateral groin dissection is not always necessary. In the past the 'en bloc' resection of the vulva and groin nodes was the standard treatment for every patient. With the introduction of the above mentioned modifications, resulting in less morbidity, more older patients can now get the standard treatment. A retrospective analysis of all patients with vulvar cancer registered in a region in the Netherlands was carried out. The objective was to determine the referral pattern and the number of patients who received standard treatment. Sixty-seven of the 138 patients were not referred to a gynecological oncology center. Of this group the patients with squamous cell cancer (n = 36) 80% did not get standard treatment. Compared with the group of patients who did get standard treatment, these patients were older (median 81 years) and had an earlier stage of the disease. A higher than expected recurrence rate of 46% and a lower than expected survival rate of 68% was found. During follow-up several patients were found to be medically fit enough to undergo extensive salvage surgery for this recurrence. From the results of this study it can be concluded that deviation from standard treatment in early vulvar cancer only on the basis of old age results in decreased survival. Only the performance status of the patient combined with clinical and pathological prognostic variables should be used to decide what treatment is best for which patient.