IMR Press / EJGO / Volume 42 / Issue 5 / DOI: 10.31083/j.ejgo4205139
Open Access Original Research
Retrospective cohort study of neoadjuvant chemotherapy followed by tailored surgery in locally advanced sphincter-threatening vulval cancer: an alternative to exenteration?
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1 Beatson West of Scotland Cancer Centre, NHS Greater Glasgow and Clyde, G12 0YN Glasgow, Scotland
2 Department of Mathematics and Statistics, University of Strathclyde, G1 1XH Glasgow, Scotland
3 Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, G4 0RE Glasgow, Scotland
4 Clinical and Protecting Health Directorate, Public Health Scotland, EH12 9EB Edinburgh, Scotland
5 Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, G31 2ER Glasgow, Scotland
6 University Hospitals, Coventry and Warwickshire, CV2 2DX Coventry, England
Eur. J. Gynaecol. Oncol. 2021 , 42(5), 917–925; https://doi.org/10.31083/j.ejgo4205139
Submitted: 12 July 2021 | Revised: 1 September 2021 | Accepted: 2 September 2021 | Published: 15 October 2021
Abstract

Objective: To determine the feasibility and overall survival (OS) outcome of utilizing neoadjuvant chemotherapy (NACT) followed by wide local excision (WLE) in women with sphincter-threatening locally advanced squamous cell carcinoma (SCC) of the vulva. Methods: The electronic chemotherapy prescribing system was used to identify patients from the West of Scotland Cancer Network (WoSCAN) who received NACT over a 5 year period, January 2012 to December 2016 inclusive. Baseline characteristics and treatment details were collected. Association of treatment type and other variables with OS were analysed using Cox proportional hazards model. Results: 57 patients with newly diagnosed SCC of the vulva were identified; recurrences were excluded. 25 patients proceeded to WLE following NACT. No permanent stomas were required. 4% of patients had a complete response with NACT alone, not undergoing surgery, and remained disease free at the study end. OS was 39.3 months (95% Confidence Interval (CI) 32.5 – Not reached (NR)) for the entire cohort and 40.1 months (95% CI 39.3 – NR) in the surgical group following median follow up of 27 months. Local recurrence was the predominant cause of failure. Conclusions: NACT followed by WLE is effective in a subgroup of patients with locally advanced vulval cancer and can minimize the extent of surgery necessary, but close monitoring is required to identify and manage relapse early.

Keywords
Vulval cancer
Neoadjuvant chemotherapy
Surgery
Radiotherapy
Wide local excision
Real-world
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