Surgery after upfront chemoradiation in locally advanced squamous cell vulvar cancer: Analysis of postoperative outcomes and survival

IF 4.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology Pub Date : 2024-10-16 DOI:10.1016/j.ygyno.2024.10.005

Alex Federico , Valentina Lancellotta , Simona M. Fragomeni , Gabriella Macchia , Sara Ammar , Tina Pasciuto , Angela Santoro , Giacomo Corrado , Alessia Piermattei , Valerio Gallotta , Luca Tagliaferri , Gianfranco Zannoni , Maria A. Gambacorta , Giovanni Scambia , Giorgia Garganese

{"title":"Surgery after upfront chemoradiation in locally advanced squamous cell vulvar cancer: Analysis of postoperative outcomes and survival","authors":"Alex Federico , Valentina Lancellotta , Simona M. Fragomeni , Gabriella Macchia , Sara Ammar , Tina Pasciuto , Angela Santoro , Giacomo Corrado , Alessia Piermattei , Valerio Gallotta , Luca Tagliaferri , Gianfranco Zannoni , Maria A. Gambacorta , Giovanni Scambia , Giorgia Garganese","doi":"10.1016/j.ygyno.2024.10.005","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>The aim of the study was to assess the survival rates and surgery-related toxicity in patients with locally advanced squamous cell vulvar cancer (LAVC) managed by upfront chemoradiation (CRT) with/without following by surgery.</div><div>CRT is the primary treatment for patients with unresectable locally advanced squamous cell vulvar carcinoma (LAVC), followed by surgery in case of residual tumor.</div></div><div><h3>Methods</h3><div>Patients with AJCC stage II-IV squamous cell vulvar carcinoma referred to Gynecologic Oncology Unit at Fondazione Policlinico Universitario Agostino Gemelli I.R.C.C.S. from January 2016 to February 2023, managed by upfront CRT, were included.</div></div><div><h3>Results</h3><div>63 patients were included, 21 (33 %) had complete response (cCR) to CRT, 26 (41 %) had partial response (cPR), 1 (2 %) stable disease (cSD), 15 (24 %) had disease progression (cPD).</div><div>In the whole population, cPR/SD and cPD were associated with reduced PFS (<em>p</em> < 0.001) and overall survival (OS) (p < 0.001), p16 expression was associated with improved PFS (p < 0.001) and OS (<em>p</em> = 0.001).</div><div>Among patients with clinical residual disease after CRT, 23 patients undergoing surgery experienced improved PFS (<em>p</em> = 0.003) and OS (p = 0.003) compared to those receiving other treatments.</div><div>Eight (35 %) patients experienced severe (grade ≥ III) postoperative complications; vulvar and groin wound dehiscence/infection were the most common complications; one (4 %) patient died in the postoperative. Patients with pathological residual disease experienced worse PFS (<em>p</em> = 0.013) and OS (<em>p</em> = 0.034).</div></div><div><h3>Conclusions</h3><div>Clinical response to CRT and p16 expression strongly predict survival in LAVC. Surgery for residual disease might be associated with improved survival but is burdened by high rates of complications. Pathologic residual disease correlates with high recurrence rates and poor survival.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"191 ","pages":"Pages 106-113"},"PeriodicalIF":4.5000,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Gynecologic oncology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0090825824011557","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Objective

The aim of the study was to assess the survival rates and surgery-related toxicity in patients with locally advanced squamous cell vulvar cancer (LAVC) managed by upfront chemoradiation (CRT) with/without following by surgery.

CRT is the primary treatment for patients with unresectable locally advanced squamous cell vulvar carcinoma (LAVC), followed by surgery in case of residual tumor.

Methods

Patients with AJCC stage II-IV squamous cell vulvar carcinoma referred to Gynecologic Oncology Unit at Fondazione Policlinico Universitario Agostino Gemelli I.R.C.C.S. from January 2016 to February 2023, managed by upfront CRT, were included.

Results

63 patients were included, 21 (33 %) had complete response (cCR) to CRT, 26 (41 %) had partial response (cPR), 1 (2 %) stable disease (cSD), 15 (24 %) had disease progression (cPD).

In the whole population, cPR/SD and cPD were associated with reduced PFS (p < 0.001) and overall survival (OS) (p < 0.001), p16 expression was associated with improved PFS (p < 0.001) and OS (p = 0.001).

Among patients with clinical residual disease after CRT, 23 patients undergoing surgery experienced improved PFS (p = 0.003) and OS (p = 0.003) compared to those receiving other treatments.

Eight (35 %) patients experienced severe (grade ≥ III) postoperative complications; vulvar and groin wound dehiscence/infection were the most common complications; one (4 %) patient died in the postoperative. Patients with pathological residual disease experienced worse PFS (p = 0.013) and OS (p = 0.034).

Conclusions

Clinical response to CRT and p16 expression strongly predict survival in LAVC. Surgery for residual disease might be associated with improved survival but is burdened by high rates of complications. Pathologic residual disease correlates with high recurrence rates and poor survival.

查看原文本刊更多论文

局部晚期鳞状细胞外阴癌前期化疗后的手术治疗：术后疗效和生存率分析

目的该研究旨在评估局部晚期鳞状细胞外阴癌（LAVC）患者接受前期化疗（CRT）并/不接受手术治疗后的生存率和手术相关毒性。CRT是不可切除的局部晚期鳞状细胞外阴癌（LAVC）患者的主要治疗方法，如有残余肿瘤，则进行手术治疗。方法纳入2016年1月至2023年2月期间转诊至Fondazione Policlinico Universitario Agostino Gemelli I.R.C.C.S.妇科肿瘤科并接受前期CRT治疗的AJCC II-IV期鳞状细胞外阴癌患者。结果63名患者中，21人（33%）对CRT有完全反应（cCR），26人（41%）有部分反应（cPR），1人（2%）病情稳定（cSD），15人（24%）病情进展（cPD）。在整个人群中，cPR/SD 和 cPD 与缩短的 PFS（p < 0.001）和总生存期（OS）（p < 0.001）有关，p16 表达与改善的 PFS（p < 0.001）和 OS（p = 0.001）有关。在CRT后有临床残留疾病的患者中，与接受其他治疗的患者相比，23例接受手术治疗的患者的PFS（p = 0.003）和OS（p = 0.003）均有所改善。8例（35%）患者出现严重的术后并发症（等级≥ III）；外阴和腹股沟伤口裂开/感染是最常见的并发症；1例（4%）患者在术后死亡。有病理残留疾病的患者PFS（p = 0.013）和OS（p = 0.034）均较差。对残留疾病进行手术治疗可能会提高生存率，但并发症发生率较高。病理残留疾病与高复发率和低生存率相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Gynecologic oncology 医学-妇产科学

CiteScore

8.60

自引率

6.40%

发文量

1062

审稿时长

37 days

期刊介绍： Gynecologic Oncology, an international journal, is devoted to the publication of clinical and investigative articles that concern tumors of the female reproductive tract. Investigations relating to the etiology, diagnosis, and treatment of female cancers, as well as research from any of the disciplines related to this field of interest, are published. Research Areas Include: • Cell and molecular biology • Chemotherapy • Cytology • Endocrinology • Epidemiology • Genetics • Gynecologic surgery • Immunology • Pathology • Radiotherapy