Grootenhuis, N.C. te (Nienke) (2015) Sentinel nodes and vulvar cancer: long-term follow-up of the Groningen International Study on sentinel nodes in vulvar cancer (GROINSS-V) I. thesis, Medicine.
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Abstract
Background: Vulvar cancer is a rare disease, the incidence is 2.4/100.000 women each year. The treatment for early-stage vulvar cancer used to consist of wide local excision of the tumor combined with an inguinofemoral lymphadenectomy. Although this treatment was effective, it also had a high morbidity rate. Therefore the sentinel node (SN) procedure was evaluated in the treatment for early-stage vulvar cancer. Two large trials; the GROningen INternational Study on Sentinel nodes in Vulvar cancer (GROINSS-V-I) and the Gynecologic Oncology Group (GOG)-173 study, have shown that this procedure is safe in patients with early-stage unifocal tumors <4 cm and with no clinical suspicious groin lymph nodes. Nowadays the SN procedure combined with local excision of the tumor is part of the standard treatment in these patients. In case of a metastatic SN, a larger or multifocal tumor or clinical suspected lymph nodes, an inguinofemoral lymphadenectomy needs to be performed. No long-term follow-up data are available for large groups of vulvar cancer patients treated with the SN procedure. Objective: In 2008 GROINSS-V-I, the largest validation trial on the SN procedure in vulvar cancer, showed that application of the SN procedure in patients with early-stage vulvar cancer is safe. The aim of the current study was to evaluate the long-term follow-up of these patients regarding recurrences and survival. Material and methods: From 2000 until 2006 GROINSS-V-I included 377 patients with unifocal squamous cell carcinoma of the vulva (T1, <4 cm) from 15 international centers. All patients underwent the SN procedure and only in case of metastatic disease in the SN an additional inguinofemoral lymphadenectomy was performed. For the present study the follow-up of these patients was evaluated and updated until March 2015. Results: The median follow-up time for all patients was 105 months (range 0 – 179). Local recurrences were diagnosed in 77/253 (30.4%) SN negative patients and in 42/124 (33.9%) SN positive patients. Median time to local recurrences for these patients was 41 months (range 2 – 128) for SN negative patients and 25.5 months (range 2 – 112) for SN positive patients. In total 58 (15.4%) patients had a second and 18 (4.8%) three or more local recurrences. In 39/253 SN negative patients (15.4%) an inguinofemoral lymphadenectomy was performed, as part of the treatment for a local recurrence. Isolated groin recurrences occurred in 6/253 (2.4%) SN negative and 8/124 (6.5%) SN positive patients. Disease-specific 10-year survival was 91% for SN negative patients compared to 65% for SN positive patients (p<.0001). For all patients, 10-year disease-specific survival decreased from 90% for patients without to 69% for patients with a local recurrence (p<.0001). Discussion and conclusions: Survival is good for patients with a negative SN, but still 30% of these patients, as well as 34% of the patients with a positive SN, will have a local recurrence. These local recurrences occur even a long time after primary treatment. Although a local recurrence is treated with curative intent, the disease-specific survival of these patients decreases significantly. The results of this study underline the importance of a long-term follow-up in patients treated for early-stage vulvar cancer. Further research is needed to investigate the etiologic risk factors for vulvar cancer and recurrences of this disease.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Oonk, Dr. Maaike H.M. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:53 |
| Last Modified: | 25 Jun 2020 10:53 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1419 |
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