Vulvar Cancer

Question 1

Risk factors for LN+ in vulvar ca per AGO-CaRE-1 German study on 1162 pts?

Answer 1

OR:

Age: 1.03 per year
LVSI: 5
Stage: 2.2
Depth of invasion: 1.08 per mm

Question 2

Risk factors for number of +LN in vulvar ca per AGO-CaRE-1 German study on 1162 pts?

Answer 2

Tumor stage OR-2.2

Question 3

What are chances of +LN in patient with >4 cm vulvar cancer per AGO-CaRE-1 German study on 1162 pts?

Answer 3

> 60%

Question 4

Clinically significant margins for vulvar cancer resection per Dutch study N-287

Answer 4

If pathological margin = or >3 mm, no increase in risk of recurrence

Recommend 10 mm surgical margin; with this approach pathologically 7% will be +, 8% will be <3mm

Question 5

Risk of local recurrence after vulvar cancer resection per Dutch study N-287 based on precursor status: (58% had lichen sclerosus as precursor lesion)

Answer 5

Actuarial: 43% /10y * driven by VIN1-2

Ranges:
28% for HGSIL
76% for pts with both lichen sclerosus and VIN1-2

Question 6

Frozen section during SLN mapping for vulvar cancer?
N 173 pts; 258 groins

Brenna Swift UoToronto; SGO 2021

Answer 6

Sensitivity: 90%
Specificity: 99.5%
PPV:97%
NPV:98%

17% underwent full LND at the same time for +FZN

2 pts delayed LND

No info about LN🔄; frozen could \ quality of final path ?

Question 7

Chances for 🔄 after CR to CCRT (concurrent chemo RT) for locally advanced vulvar ca?

Answer 7

30%

Question 8

Recommend XRT dose for CCRT (concurrent chemo RT) for locally advanced vulvar ca by Thomas?

Answer 8

55 Gy for preoperative CCRT

65 Gy for definitive CCRT

Question 9

GROINS-V-II: what happened after stopping rule was activated (91 SLN+💃🏻; 9/10🔄 had metz w/ history of >2mm size tumor in initial SLN)

Answer 9

For macrometastasis (>2mm) tx was reverted to IFL (inguinofemoral LND) instead of 50 Gy XRT

IFL with adjuvant XRT if > 1 LN+ or extracapsular spread

Question 10

GROINS-V-II 2021: SLN w/ micrometastasis: % of pts, % of metz, risk of isolated groin 🔄 vs. macrometstasis:

Answer 10

<4cm vulvar cancer with 21% mSLN (half >2”):

2y isolated groin 🔄:
4% SLN micrometz vs. 7% IFL +/- XRT vs 22% XRT - 50 Gy only (dose for subclinical metz)

Question 11

GROINS-V II: quality control for SLN procedure before enrolling pts:

Answer 11

Centers w/ no prior experience: at least ten successful SLN detections during IFL

Experience in other sites: 5

Experienced Gyn w/ vulvar SLN: no need

Question 12

Vulvar ca: risk of LN spread ~ depth of invasion and tumor size 2 cm cut off?

Answer 12

<1”: 0%
1-3”: 8%
3-5”: 33%
>5”: 48%

<2 cm - 19%

> 2 cm - 42%

Principles of Gyn Onc surgery

Question 13

Lateral ambiguous vulvar lesion (medial border <2cm from midline but not crossing the border): % of patients with unilateral drainage only in Preop scintigraphy and risk of metz in contra lateral basin?

Answer 13

42% has only unilateral drainage

Those cases had no contralateral metz

Question 14

GROINS-V-I: observational study 2000-06: enrollment criteria

Answer 14

T1 SQCC

No vaginal, urethra or anus involvement

Pts with multi focal disease were subsequently excluded

Question 15

GROINS-V-I: observational study 2000-06: how often and by which mode mSLN were detected?

Answer 15

26% of groins

58% detected by routine pathology - 42% by microstaging

Question 16

GROINS-V-I: observational study 2000-06:complications of SLNm vs SLN + IFL

Answer 16

Wound breakdown: 12 vs 34%

Cellulitis: 5 vs 21%

Lymphedema: 2 vs. 25%

🔃 erisipelas: 0.4 vs 16%

Question 17

GROINS-V-I: unifocal disease; IFL for SLNm with half getting XRT: median 9 y follow up results:

Answer 17

DSS ~ 2mm cut off for SLNm:
95 vs 70% (p=0.001)

No isolated distant 🔄 among SLN negative pts

For SLNm pts: isolated groin 🔄 at 3 and 8% at 5 & 10y respectively

DSS for SLN neg and positive was: 94-91% vs 76-65% at 5 & 10y respectively