Skip to main content

Advertisement

SpringerLink
Log in

Advanced Vulvar Cancers: What are the Best Options for Treatment?

  • Gynecologic Cancers (NS Reed, Section Editor)
  • Published:
Current Oncology Reports Aims and scope Submit manuscript

Abstract

The treatment of patients with vulvar cancer remains challenging for gynecologic oncologists. Up to 30 % of the cases are diagnosed in a clinical condition of irresectability, and some kind of strategy has to be taken into account beyond surgery. In this regard, a common and standard definition is critical to maximize oncological results and minimize complications after treatments. Each patient treatment must be tailored individually according to their clinical and biological features and to the setting in which they are dealing with.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Benedet JL, Bender H, Jones 3rd H, et al. FIGO staging classifications and clinical practice guidelines in the management of gynecologic cancers. FIGO Committee on Gynecologic Oncology. Int J Gynaecol Obstet. 2000;70:209–62.

    Article  CAS  PubMed  Google Scholar 

  2. Judson PL, Habermann EB, Baxter NN, et al. Trends in the incidence of invasive and in situ vulvar carcinoma. Obstet Gynecol. 2006;107:1018–22.

    Article  PubMed  Google Scholar 

  3. Jemal A, Siegel R, Ward E, et al. Cancer statistics. CA Cancer J Clin. 2006;56:106–30.

    Article  PubMed  Google Scholar 

  4. Stroup AM, Harlan LC, Trimble EL. Demographic, clinical and treatment trends among women diagnosed with vulvar cancer in the United States. Gynecol Oncol. 2008;108:577–83.

    Article  CAS  PubMed  Google Scholar 

  5. Aragona AM, Cuneo NA, Soderini AH. Epidemiology of gynecological cancers. Scientific conference of the Oncology Hospital of Buenos Aires Marie Curie 80th anniversary. Autonomous City of Buenos Aires. 2011.

    Google Scholar 

  6. Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet. 2009;105:103–4.

    Article  PubMed  Google Scholar 

  7. Sobin LH, Gospodarowicz MK, Wittekind CH, editors. TNM classification of malignant tumours. 7th ed. Oxford: Wiley- Blackwell; 2009.

    Google Scholar 

  8. Aragona AM, Soderini AH, Cuneo NA. Defining the concept of locally advanced squamous cell carcinoma of the vulva: a new perspective based on standardization of criteria and current evidence. J Gynecol Oncol. 2014;25(4):272–8.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Aragona AM, Cuneo NA, Soderini AH, Alcoba EB. An analysis of reported independent prognostic factors for survival in squamous cell carcinoma of the vulva: is tumor size significance being underrated? Gynecol Oncol. 2014;132(3):643–8. The concept of a new subgroup of risk, which allows a better stratification for treatment selection, has been introduced by the authors.

    Article  PubMed  Google Scholar 

  10. Benedetti-Panici P, Greggi S, Scambia G, et al. Cisplatin (P), bleomycin (B), and methotrexate (M) preoperative chemotherapy in locally advanced vulvar carcinoma. Gynecol Oncol. 1993;50:49–53.

    Article  CAS  PubMed  Google Scholar 

  11. Belinson JL, Stewart JA, Richards AL, et al. Bleomycin, vincristine, mitomycin-C, and cisplatin in the management of gynecologic squamous cell carcinomas. Gynecol Oncol. 1985;20:387–93.

    Article  CAS  PubMed  Google Scholar 

  12. Wagenaar HC, Colombo N, Vergote I, et al. Bleomycin, methotrexate, and CCNU in locally advanced or recurrent, inoperable squamous-cell carcinoma of the vulva: an EORTC Gynaecological Cancer Cooperative Group Study. European Organization for Research and Treatment of Cancer Gynecol Oncol. 2001;81:348.

    CAS  PubMed  Google Scholar 

  13. Geisler JP, Manahan KJ, Buller RE. Neoadjuvant chemotherapy in vulvar cancer: avoiding primary exenteration. Gynecol Oncol. 2006;100:53–7.

    Article  CAS  PubMed  Google Scholar 

  14. Witteveen PO, Van der Velden J, Vergote I, et al. Phase II study on paclitaxel in patients with recurrent, metastatic or locally advanced vulvar cancer not amenable to surgery or radiotherapy: a study of the EORTC-GCG (European Organisation for Research and Treatment of Cancer Gynaecological Cancer Group). Ann Oncol. 2009;20:1511–6. 19.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Domingues AP, Mota F, Durao M, et al. Neoadjuvant chemotherapy in advanced vulvar cancer. Int J Gynecol Cancer. 2010;20:294–8.

    Article  PubMed  Google Scholar 

  16. Aragona AM, Cuneo N, Soderini AH, Alcoba E, Greco A, Reyes C, et al. Tailoring the treatment of locally advanced squamous cell carcinoma of the vulva: neoadjuvant chemotherapy followed by radical surgery: results from a multicenter study. Int J Gynecol Cancer. 2012;22(7):1258–63. The largest prospective study published to date regarding the topic. Neoadjuvant chemotherapy produced a considerable response rate >80% and the 5-year survival rate following surgery was >92%.

    Article  PubMed  Google Scholar 

  17. Reade CJ, Eiriksson LR, Mackay H. Systemic therapy in squamous cell carcinoma of the vulva: current status and future directions. Gynecol Oncol. 2014;132(3):780–9.

    Article  PubMed  Google Scholar 

  18. Deppe G, Mert I, Winer IS. Management of squamous cell vulvar cancer: a review. J Obstet Gynaecol Res. 2014;40(5):1217–25.

    Article  PubMed  Google Scholar 

  19. Chan JK, Sugiyama V, Pham H, Gu M, Rutgers J, Osann K, et al. Margin distance and other clinico-pathologic prognostic factors in vulvar carcinoma: a multivariate analysis. Gynecol Oncol. 2007;104:636–41.

    Article  PubMed  Google Scholar 

  20. Moore DH, Thomas GM, Montana GS, Saxer A, Gallup DG, Olt G. Preoperative chemoradiation for advanced vulvar cancer: a phase II study of the Gynecologic Oncology Group. Int J Radiat Oncol Biol Phys. 1998;42(1):79–85.

    Article  CAS  PubMed  Google Scholar 

  21. De Hullu JA, Hollema H, Lolkema S, Boezen M, Boonstra H, Burger MP, et al. Vulvar carcinoma. The price of less radical surgery. Cancer. 1992;95(11):2331–8.

    Article  Google Scholar 

  22. Heaps JM, Fu YS, Montz FJ, Hacker NF, Berek JS. Surgical-pathologic variables predictive of local recurrence in squamous cell carcinoma of the vulva. Gynecol Oncol. 1990;38(3):309–14.

    Article  CAS  PubMed  Google Scholar 

  23. Homesley HD, Bundy BN, Sedlis A, Adcock L. Radiation therapy versus pelvic node resection for carcinoma of the vulva with positive groin nodes. Obstet Gynecol. 1986;68:733–40.

    CAS  PubMed  Google Scholar 

  24. Parthasarathy A, CheungMK OK, Husain A, TengNN BJS, et al. The benefit of adjuvant radiation therapy in single node positive squamous cell vulvar carcinoma. Gynecol Oncol. 2006;103:1095–9.

    Article  PubMed  Google Scholar 

  25. Moore DH, Ali S, Koh WJ, Michael H, Barnes MN, McCourt CK, et al. A phase II trial of radiation therapy and weekly cisplatin chemotherapy for the treatment of locally- advanced squamous cell carcinoma of the vulva: a gynecologic oncology group study. Gynecol Oncol. 2012;124(3):529–33. Pioneering GOG publication as for chemoradiation in vulvar cancer.

    Article  CAS  PubMed  Google Scholar 

  26. Shylasree TS, Bryant A, Howells RE. Chemoradiation for advanced primary vulval cancer. Cochrane Database Syst Rev. 2011;4:CD003752.

    PubMed  Google Scholar 

  27. Bortolozzi G, Arnoletti E, Belloni C, et al. New integrated therapy in vulvar cancer. Proceedings of International Meeting of Gynecologic Oncology. 1985;420.

  28. Strzinar V, Kocijan A, Kovacic J, et al. Adriamycin and bleomycin in treatment of advanced or recurrent squamous cell carcinoma of the vulva. Proceedings of International Meeting of Gynecologic Oncology. 1985;408:15Y19.

    Google Scholar 

  29. Itala J, Belardi G, Sardi J, et al. Poliquimioterapia neoadyuvante en el tratamiento del carcinoma invasor de la vulva. Revista de la Sociedad de Obstetricia y Ginecologı´a de Buenos Aires (SOGIBA). 1986;865:239Y245.

    Google Scholar 

  30. Shimizu Y, Hasumi K, Masubuchi K. Effective chemotherapy consisting of bleomycin, vincristine, mitomycin C, and cisplatin (BOMP) for a patient with inoperable vulvar cancer. Gynecol Oncol. 1990;36:423Y427.

    Article  Google Scholar 

  31. Sardi JE, Di Paola GR, et al. A possible new trend in the management of the carcinoma of the cervix uteri. Gyn Oncol. 1986;25:139.

    Article  CAS  Google Scholar 

  32. Giaroli A, Sananes C, Sardi JE, Maya AG, Bastardas ML, Snaidas L, et al. Lymph node metastases in carcinoma of the cervix uteri: response to neoadjuvant chemotherapy and its impact on survival. Gynecol Oncol. 1990;39(1):34–7.

    Article  CAS  PubMed  Google Scholar 

  33. Sardi JE, Sananes C, Giaroli A, et al. Neoadjuvant chemotherapy in locally advanced carcinoma of the cervix uteri. Gynecologic Oncology. 1990;38:486–93.

    Article  CAS  PubMed  Google Scholar 

  34. Sardi J, Giaroli A, Sananes C, Rueda NG, Vighi S, Ferreira M, et al. Randomized trial with neoadjuvant chemotherapy in stage IIIB squamous carcinoma cervix uteri: an unexpected therapeutic management. International Journal of Gynecological Cancer. 1996;6(2):85–93.

    Article  Google Scholar 

  35. Sardi J, Giaroli A, Sananes C, et al. Long term follow up of the first randomized trial using neoadjuvant chemotherapy in stage Ib squamous carcinoma of the cervix: the final results. Gynecol Oncol. 1997;67:61–9.

    Article  CAS  PubMed  Google Scholar 

  36. Sananes C, Giaroli A, Soderini A, Guardado N, Sanaidas L, Bermúdez A, et al. Neoadjuvant chemotherapy followed by radical hysterectomy and postoperative adjuvant chemotherapy in the treatment of carcinoma of the cérvix uteri: long-term follow up of a pilot study. Eur J Gynaecol Oncol. 1998;19(4):368–73.

    CAS  PubMed  Google Scholar 

  37. Sardi S, Giaroli B, Ferreira S, Snaidas G, Anchezar Contreras O, Di P. Neoadjuvant chemotherapy in cervical carcinoma stage IIB: a randomized controlled trial. International Journal of Gynecological Cancer. 1998;8(6):441–50.

    Article  Google Scholar 

  38. Tierney J. Neoadjuvant chemotherapy for locally advanced cervical cancer: a systematic review and meta-analysis of individual patient data from 21 randomised trials. Neoadjuvant Chemotherapy for Locally Advanced Cervical Cancer Meta-analysis Collaboration. Eur J Cancer. 2003;39(17):2470–86. Review.

    Article  Google Scholar 

  39. Francesco R, Flavia Z, Fabio M, Santiago C, Joel L, Antonino D. Role of paclitaxel and cisplatin as the neoadjuvant treatment for locally advanced squamous cell carcinoma of the vulva. J Gynecol Oncol. 2014;25(1):22–9.

    Article  Google Scholar 

  40. de Vulva C, Azcune. Guias para el diagnóstico, tratamiento y segimiento del cáncer ginecológico.Asociacion Argentina de Ginecología Oncológica. 2013. p. 13–32.

    Google Scholar 

Download references

Acknowledgments

To Nicasio Cuneo, a great boss and better friend.

Author information

Authors and Affiliations

  1. Oncologic Hospital of Buenos Aires “Marie Curie”, Buenos Aires, Argentina

    Alejandro Soderini & Alejandro Aragona

  2. Beatson Oncology Centre, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, Scotland, UK

    Nicholas Reed

Authors
  1. Alejandro Soderini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alejandro Aragona
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nicholas Reed
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alejandro Soderini.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Gynecologic Cancers

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Soderini, A., Aragona, A. & Reed, N. Advanced Vulvar Cancers: What are the Best Options for Treatment?. Curr Oncol Rep 18, 64 (2016). https://doi.org/10.1007/s11912-016-0545-6

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11912-016-0545-6

Keywords

Search

Navigation