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Conservative Vulvar Ca Therapy Easier on Patients.
HOT SPRINGS, VA. -- Increasingly conservative approaches to treating patients with invasive squamous cancers of the vulva haven't compromised outcomes and have spared many patients considerable morbidity associated with extensive surgical excision.
That conclusion, based on data on patients treated at the University of Virginia over a 16-year period, underscores the relative success of conservative vulvar cancer treatments. Such procedures have been used more freely following the introduction of a surgical staging system by the International Federation of Gynecology and Obstetrics in 1989, replacing less dependable clinical staging techniques.
Among the management improvements precipitated by surgical staging, the elimination of simultaneous groin node dissection for select patients "represents the most dramatic change in vulvar cancer treatment noted at the University of Virginia," Dr. Laura D. Maple explained at the annual meeting of the South Atlantic Association of Obstetricians and Gynecologists.
In the study, Dr. Maple and her colleagues at the university compared outcomes for 171 women who underwent treatment for invasive squamous vulvar cancer, stages I-IV, from 1980 through 1996. All the tumors had at least 1 mm of invasion.
Treatment outcomes were compared for four management approaches: vulvar and groin node resection, otherwise known as "standard" surgical therapy; vulvar resection only, without groin node resection; radiation plus planned surgery; or radiation therapy only.
Groin nodal status based on surgical pathology was known before initial treatment for 72 patients. Regardless of the clinical stage, if nodes were positive, the 5-year actuarial survival rate was 33%, compared with 84% for negative nodal status.
Still, despite these survival differences based on nodal status, removing nodes didn't appear to have much impact on survival. Among those patients with stage. I or II disease, the 5-year actuarial survival rate for those undergoing radical vulvar and groin resection was 79%, compared with 80% for patients undergoing radical vulvar surgery without simultaneous groin node dissection.
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Source: HighBeam Research, Conservative Vulvar Ca Therapy Easier on Patients.