Vulvar/Vaginal

Question 1

Name the 2 pathways with the precursor lesions to development of vulvar cancer

Answer 1

1. Lichen sclerosus
2. Differentiated vulvar intraepithelial neoplasia (dVIN)
   - caused by persistent HPV–>HSIL
   - consider re-excision if dVIN at margin, given high risk of recurrence

Question 2

Indications for adjuvant RT

Answer 2

1. Post op inguinal & pelvic ET warranted in patients w/ >1 intranodal mets
2. Extranodal tumor growth after full inguino-femoral LND
3. Presence of + margins and dz not amenable to re-excision

• RT rose 50 Gy w/ micro invasive mets, 60 Gy w/ multiple + nodes or extra capsular spread. Chemo w/ RT decreases risk of death

Question 3

What did the GROINS-V studies show?

Answer 3

GROINS-V II (GOG 270) was a prospective observational trial of inguinal sLND in vulvar SCC <4cm —-> if neg sLND recurrence rate is 2%.
*also showed nodal mets >2mm have higher risk recurrence despite adjuvant RT

• this validates results from GROINS-V which reported 5 yr inguinal recurrence rate 2.5%
• supports safety of omitting full inguinal LND in small unifocal SCC