scholarly journals Risk for Pelvic Metastasis and Role of Pelvic Lymphadenectomy in Node-Positive Vulvar Cancer-Results from the AGO-VOP.2 QS Vulva Study

Cancers ◽  
2022 ◽  
Vol 14 (2) ◽  
pp. 418
Author(s):  
Linn Woelber ◽  
Monika Hampl ◽  
Christine zu Eulenburg ◽  
Katharina Prieske ◽  
Johanna Hambrecht ◽  
...  
Keyword(s):  
Vulvar Cancer ◽  
Recurrent Disease ◽  
Gynecologic Oncology ◽  
Pelvic Lymphadenectomy ◽  
Nodal Status ◽  
Nodal Involvement ◽  
Node Positive ◽  
Multicenter Analysis ◽  
Pelvic Metastasis

The need for pelvic treatment in patients with node-positive vulvar cancer (VSCC) and the value of pelvic lymphadenectomy (LAE) as a staging procedure to plan adjuvant radiotherapy (RT) is controversial. In this retrospective, multicenter analysis, 306 patients with primary node-positive VSCC treated at 33 gynecologic oncology centers in Germany between 2017 and 2019 were analyzed. All patients received surgical staging of the groins; nodal status was as follows: 23.9% (73/306) pN1a, 23.5% (72/306) pN1b, 20.4% (62/306) pN2a/b, and 31.9% (97/306) pN2c/pN3. A total of 35.6% (109/306) received pelvic LAE; pelvic nodal involvement was observed in 18.5%. None of the patients with nodal status pN1a or pN1b and pelvic LAE showed pelvic nodal involvement. Taking only patients with nodal status ≥pN2a into account, the rate of pelvic involvement was 25%. In total, adjuvant RT was applied in 64.4% (197/306). Only half of the pelvic node-positive (N+) patients received adjuvant RT to the pelvis (50%, 10/20 patients); 41.9% (122/291 patients) experienced recurrent disease or died. In patients with histologically-confirmed pelvic metastases after LAE, distant recurrences were most frequently observed (7/20 recurrences). Conclusions: A relevant risk regarding pelvic nodal involvement was observed from nodal status pN2a and higher. Our data support the omission of pelvic treatment in patients with nodal status pN1a and pN1b.

Postoperative Adjuvant Chemotherapy for Node-Positive Cervical Adenocarcinoma

2009 ◽  
Vol 19 (2) ◽  
pp. 277-280 ◽  
Author(s):  
Nobuhiro Takeshima ◽  
Kuniko Utsugi ◽  
Katsuhiko Hasumi ◽  
Ken Takizawa
Keyword(s):  
Adjuvant Chemotherapy ◽  
Clinical Stage ◽  
Disease Free Survival ◽  
Pelvic Lymphadenectomy ◽  
Cervical Adenocarcinoma ◽  
Postoperative Chemotherapy ◽  
Postoperative Adjuvant Chemotherapy ◽  
Free Survival ◽  
Node Positive

We examined the effectiveness of postoperative adjuvant chemotherapy for node-positive cervical adenocarcinoma. During the period from 1994 to 2002, 98 consecutive patients with clinical stage I and II cervical adenocarcinoma were treated surgically without having undergone any prior treatment. Surgical procedures included radical hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy. Postoperatively, 21patients were found to have lymph node metastasis, and all were treated with chemotherapy in the absence of radiotherapy. All patients were followed up for at least 5 years. Recurrence developed in 9 of the 21 patients, all 9died of the disease. Six of the 9 recurrences were extrapelvic lesions. Five-year disease-free survival and overall survival were 57% and 67%, respectively. Recurrence was more common in patients with 6 or more positive nodes than in those with fewer than 3 positive nodes. These data suggest the potential role of postoperative chemotherapy for treatments of cervical adenocarcinoma. However, the effectiveness of chemotherapy alone in node-positive cervical adenocarcinoma was likely not as high as that in squamous cell carcinoma. Despite our use of postoperative chemotherapy in the absence of pelvic radiation, the disease recurred predominantly at distant sites.

scholarly journals Role of Pelvic Lymph Node Resection in Vulvar Squamous Cell Cancer: A Subset Analysis of the AGO-CaRE-1 Study

2021 ◽  
Author(s):  
Linn Woelber ◽  
Mareike Bommert ◽  
Philipp Harter ◽  
Katharina Prieske ◽  
Christine zu Eulenburg ◽  
...  
Keyword(s):  
Lymph Node ◽  
Squamous Cell ◽  
Squamous Cell Cancer ◽  
Cell Cancer ◽  
Median Number ◽  
Pelvic Lymph Node ◽  
Maximum Diameter ◽  
Nodal Involvement ◽  
Node Positive

Abstract Background As the population at risk for pelvic nodal involvement remains poorly described, the role of pelvic lymphadenectomy (LAE) in vulvar squamous cell cancer (VSCC) has been a matter of discussion for decades. Methods In the AGO-CaRE-1 study, 1618 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB or higher primary VSCC treated at 29 centers in Germany between 1998 and 2008 were documented. In this analysis, only patients with pelvic LAE (n = 70) were analyzed with regard to prognosis and correlation between inguinal and pelvic lymph node involvement. Results The majority of patients had T1b/T2 tumors (n = 47; 67.1%), with a median diameter of 40 mm (2–240 mm); 54/70 patients (77.1%) who received pelvic LAE had positive groin nodes. For 42 of these 54 patients, the number of affected groin nodes had been documented as a median of 3; 14/42 (33.3%) of these patients had histologically confirmed pelvic nodal metastases (median number of affected pelvic nodes 3 [1–12]). In these 14 patients, the median number of affected groin nodes was 7 (1–30), with a groin metastases median maximum diameter of 42.5 mm (12–50). Receiver operating characteristic analysis showed an area under the curve of 0.85, with 83.3% sensitivity and 92.6% specificity for the prediction of pelvic involvement in cases of six or more positive groin nodes. No cases of pelvic nodal involvement without groin metastases were observed. Prognosis in cases of pelvic metastasis was poor, with a median progression-free survival of only 12.5 months. Conclusion For the majority of node-positive patients with VSCC, pelvic nodal staging appears unnecessary since a relevant risk for pelvic nodal involvement only seems to be present in highly node-positive disease.

scholarly journals Pelvic lymphadenectomy in vulvar cancer and its impact on prognosis and outcome

2021 ◽  
Author(s):  
A. Jaeger ◽  
K. Prieske ◽  
S. Mathey ◽  
I. Fischer ◽  
E. Vettorazzi ◽  
...  
Keyword(s):  
Lymph Node ◽  
Medical Center ◽  
Cell Cancer ◽  
Progression Free Survival ◽  
Figo Stage ◽  
Lymph Node Involvement ◽  
Pelvic Lymphadenectomy ◽  
Nodal Involvement ◽  
Node Positive ◽  
Node Involvement

Abstract Background The value of pelvic lymphadenectomy (LAE) has been subject of discussions since the 1980s. This is mainly due to the fact that the relation between lymph node involvement of the groin and pelvis is poorly understood and therewith the need for pelvic treatment in general. Patients and Methods N = 514 patients with primary vulvar squamous cell cancer (VSCC) FIGO stage ≥ IB were treated at the University Medical Center Hamburg-Eppendorf between 1996 and 2018. In this analysis, patients with pelvic LAE (n = 21) were analyzed with regard to prognosis and the relation of groin and pelvic lymph node involvement. Results The majority had T1b/T2 tumors (n = 15, 78.9%) with a median diameter of 40 mm (11–110 mm). 17/21 patients showed positive inguinal nodes. Pelvic nodal involvement without groin metastases was not observed. 6/17 node-positive patients with positive groin nodes also had pelvic nodal metastases (35.3%; median number of affected pelvic nodes 2.5 (1–8)). These 6 patients were highly node positive with median 4.5 (2–9) affected groin nodes. With regard to the metastatic spread between groins and pelvis, no contralateral spread was observed. Five recurrences were observed after a median follow-up of 33.5 months. No pelvic recurrences were observed in the pelvic nodal positive group. Patients with pelvic metastasis at first diagnosis had a median progression-free survival of only 9.9 months and overall-survival of 31.1 months. Conclusion A relevant risk for pelvic nodal involvement only seems to be present in highly node-positive disease, therefore pelvic staging (and radiotherapy) is probably unnecessary in the majority of patients with node-positive VSCC.

Role of adjuvant external beam radiotherapy and chemotherapy in one versus two or more node-positive vulvar cancer: A National Cancer Database study

2018 ◽  
Vol 129 (3) ◽  
pp. 534-539 ◽  
Author(s):  
Nicholas R. Rydzewski ◽  
Margaux J. Kanis ◽  
Eric D. Donnelly ◽  
John R. Lurain ◽  
Jonathan B. Strauss
Keyword(s):  
Vulvar Cancer ◽  
External Beam Radiotherapy ◽  
External Beam ◽  
National Cancer Database ◽  
Database Study ◽  
Node Positive

The role of adjuvant radiation and chemoradiation in single node-positive vulvar cancer

2014 ◽  
Vol 133 ◽  
pp. 36-37
Author(s):  
R.A. Laskey ◽  
M.S. Ross ◽  
J.F. Lin ◽  
P. Sukumvanich ◽  
T.C. Krivak ◽  
...  
Keyword(s):  
Vulvar Cancer ◽  
Adjuvant Radiation ◽  
Single Node ◽  
Node Positive

T2 Gallbladder Cancer—Aggressive Therapy is Warranted

2016 ◽  
Vol 82 (6) ◽  
pp. 518-521 ◽  
Author(s):  
Mohd Raashid Sheikh ◽  
Houssam Osman ◽  
Susannah Cheek ◽  
Shenee Hunter ◽  
Dhiresh Rohan Jeyarajah
Keyword(s):  
Clinical Presentation ◽  
Radical Surgery ◽  
Radical Resection ◽  
Gall Bladder Cancer ◽  
Incidental Diagnosis ◽  
Radical Cholecystectomy ◽  
Node Positive ◽  
Operative Findings ◽  
Worse Prognosis

Treatment of gall bladder cancer (GBC) has traditionally been viewed with pessimism and lymph node positivity has been associated with worse prognosis. The aim of this study is to analyze the role of radical cholecystectomy in T2 tumors. All patients who underwent surgery for GBC between September 2005 and June 2014 were identified retrospectively. Data collected included clinical presentation, operative findings, and histopathological data. Twenty-five patients had incidental GBC diagnosis after cholecystectomy. Ten patients were T2 on initial cholecystectomy pathology and all underwent radical resection. Two patients were N1 on initial cholecystectomy pathology. Four were upstaged to N1 and two patients were upstaged to T3 after further surgery. Overall, 60 per cent patients with T2 disease had node positivity and 60 per cent were upstaged by further surgery. Eleven patients were diagnosed on imaging. Four of these patients were unresectable and six were either stage T3 or higher or node positive. Sixty per cent of T2 GBC was node positive and 60 per cent were upstaged with radical cholecystectomy. This finding supports the call for radical resection in patients with incidental diagnosis of T2 tumor on cholecystectomy. This study also emphasizes the role of radical surgery in accurate T staging.

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