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Long-term outcomes of individualized management after sentinel lymph-node biopsy for vulvar cancer

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Abstract

Background

The management for patients with vulvar cancer after sentinel lymph-node biopsy (SLNB) remains controversial. The aim of this study was to investigate the long-term outcomes of individualized management after SLNB for early stage vulvar cancer.

Methods

The medical records of patients with vulvar cancer treated by surgery involving SLNB between 2004 and 2019 were retrospectively reviewed. During this period, the inguinofemoral lymphadenectomy (IL) were performed with individualized strategy, while the postoperative intensity-modulated radiotherapy was planned with a consistent policy.

Results

We identified 138 patients with at least one sentinel node detected, of whom 64 underwent further IL while 74 had SLNB only. Nodal metastases (pN+) were confirmed in 22 patients with IL and 16 without. Radiotherapy was scheduled with the dose of 60–70 Gy for all pN+ patients and finally completed in 15 with IL and 15 without. The median follow-up time was 56 months (6–156 months). Recurrence was observed in 24 patients, of whom 10 were pN- at primary treatment. The 3-year overall survival (OS) was 97.2, 95.2, 68.3, and 71.8%; 3-year disease-free survival (DFS) was 94.5, 91.4, 60.2, and 59.2%, respectively, for patients with pN− and IL, pN− and SLNB, pN+ and IL, and pN+ and SLNB. Neither OS nor DFS showed significant difference between SLNB and IL in pN− (P = 0.564 for OS, P = 0.423 for DFS), or pN + patients (P = 0.920 for OS, P = 0.862 for DFS).

Conclusions

With appropriate adjuvant radiotherapy, SLNB alone provided similar long-term survival compared with IL for both patients with and without sentinel node metastasis.

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Availability of data and materials

The raw data of this study are available from the corresponding author upon reasonable request.

Abbreviations

VC:

Vulvar cancer

SCC:

Squamous cell carcinoma

LNM:

Lymph-node metastasis

SLNB:

Sentinel lymph-node biopsy

SLN:

Sentinel lymph node

IL:

Inguinofemoral lymphadenectomy

GOG:

Gynecologic Oncology Group

CT:

Computerized tomography

GTVnd:

Gross tumor volume of lymph node

CTV:

Clinical target volume

OS:

Overall survival

DFS:

Disease-free survival

FIGO:

International Federation of Gynecology and Obstetrics

NCCN:

National Comprehensive Cancer Network

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Acknowledgements

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Funding

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Author notes

  1. Haifeng Gu and Guochen Liu contributed equally to this study.

Authors and Affiliations

  1. Department of Gynecologic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 East Dongfeng Road, Guangzhou, China

    Haifeng Gu, Guochen Liu, Jieping Chen, Zhimin Liu & Hua Tu

  2. Department of Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China

    Junyun Li

  3. Department of Pathology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China

    Xinke Zhang

Authors
  1. Haifeng Gu
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  2. Guochen Liu
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  3. Junyun Li
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  4. Jieping Chen
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  5. Xinke Zhang
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  7. Hua Tu
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Contributions

HF-G and GC-L: project development, data collection, data analysis, and manuscript writing; JY-L: data collection and analysis; JP-C and XK-Z: data collection; ZM-L and HT: project development, data analysis, and manuscript writing and editing.

Corresponding authors

Correspondence to Zhimin Liu or Hua Tu.

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The authors declare that they have no conflict of interest.

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This study was approved by the Institutional Review Board of Sun Yat-sen University Cancer Center.

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Written informed consents for publication were obtained.

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Gu, H., Liu, G., Li, J. et al. Long-term outcomes of individualized management after sentinel lymph-node biopsy for vulvar cancer. Int J Clin Oncol 26, 784–793 (2021). https://doi.org/10.1007/s10147-020-01838-z

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  • DOI: https://doi.org/10.1007/s10147-020-01838-z

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