Management of Vulvar Cancer

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (31 January 2022) | Viewed by 46552

Special Issue Editors

Department of Woman's and Child Health and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
Interests: gynecologic oncology; electrochemotherapy; oncofertility
Special Issues, Collections and Topics in MDPI journals
1. Gynecology and Breast Care Center, Mater Olbia Hospital, Strada Statale 125 Orientale Sarda, 07026 Olbia, Italy
2. Department of Life Sciences and Public Health, Catholic University of the Sacred Heart, L.go A. Gemelli 8, 00168 Rome, Italy
Interests: gynecologic oncology; vulvar pathology; breast cancer; oncoplastic surgery; invasive diagnostics
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Vulvar cancer (VC) is a rare malignancy, accounting for an estimated 5.6% of all gynecologic malignancies and 3.7% of gynecologic cancer deaths. Ninety percent of primary VCs are squamous cell carcinoma (SCC), while other rare histologies include Bartholin gland adenocarcinoma, melanoma, extra-mammary Paget’s disease, verrucous carcinoma, basal cell carcinoma, and sarcoma. Risk factors for the development of vulvar neoplasia include old age, human papillomavirus infection, cigarette smoking, inflammatory conditions, and immunodeficiency.A surgical and reconstructive treatment approach has so far been a cornerstone of the different strategies at both initial and advanced stages. Significant advances have been made over time in pre-operative work-up and surgical planning, turning from 'en-bloc' surgery, which is burdened by the highest morbidity, to more conservative approaches without compromising oncologic safety.Moreover, the integration with other treatments, such as radio–chemotherapy, brachytherapy, or electrochemotherapy, has improved overall clinical outcomes, allowing for additional opportunity even in cases unsuitable for upfront surgery.The benefits of personalized approaches by multidisciplinary integration are also clearly emerging, with the need to address cases to dedicated reference centers. Sample collection and data sharing should be encouraged to achieve a specific molecular profile and to design new translational pathways.This Special Issue will provide new insights into the experimental, translational, and clinical field of VC.We welcome the submission of original research articles and reviews on these relevant topics for each major vulvar malignancy, their respective prognoses, and current management recommendations.

Dr. Giacomo Corrado
Prof. Giorgia Garganese
Guest Editors

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Keywords

  • vulvar cancer
  • multidisciplinary treatment
  • personalized approach

Published Papers (12 papers)

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Editorial

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3 pages, 197 KiB  
Editorial
Leading New Frontiers in Vulva Cancer to Build Personalized Therapy
by Giacomo Corrado and Giorgia Garganese
Cancers 2022, 14(24), 6027; https://doi.org/10.3390/cancers14246027 - 07 Dec 2022
Cited by 2 | Viewed by 705
Abstract
Approximately 3 in 1000 women will receive a diagnosis of vulvar cancer at some point in their lives [...] Full article
(This article belongs to the Special Issue Management of Vulvar Cancer)

Research

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9 pages, 2978 KiB  
Article
Reconstructive Surgery versus Primary Closure following Vulvar Cancer Excision: A Wide Single-Center Experience
by Mustafa Zelal Muallem, Jalid Sehouli, Andrea Miranda, Helmut Plett, Ahmad Sayasneh, Yasser Diab, Jumana Muallem and Imad Hatoum
Cancers 2022, 14(7), 1695; https://doi.org/10.3390/cancers14071695 - 26 Mar 2022
Cited by 2 | Viewed by 2393
Abstract
(1) Background: plastic reconstruction in vulvar surgery can lead to a better treatment outcome than primary closure. This study aims to compare the preoperative parameters (co-morbidities and tumor size) and postoperative results (tumor free margins and wound healing) between the primary closure and [...] Read more.
(1) Background: plastic reconstruction in vulvar surgery can lead to a better treatment outcome than primary closure. This study aims to compare the preoperative parameters (co-morbidities and tumor size) and postoperative results (tumor free margins and wound healing) between the primary closure and reconstructive surgery after vulvar cancer surgery; (2) Methods: this is a retrospective analysis of prospectively collected data from 2009 to 2021 at a tertiary cancer institution; (3) Results: 177 patients were included in the final analysis (51 patients had primary closure PC and 126 had reconstructive surgery RS). About half (49%) of the PC patients had no co-morbidities (p = 0.043). The RS group had a 45 mm median maximal tumor diameter compared to the PC group’s 23 mm (p = 0.013). More than 90% of RS and 80% of PC had tumor-free margins (p = 0.1). Both groups had anterior vulvar excision as the most common surgery (52.4% RS vs. 23.5% PC; p = 0.001). Both groups had identical rates of wound healing disorders. In a median follow-up of 39 months; recurrent disease was found in 23.5% of PC vs. 10.3% in RS (p = 0.012). In terms of overall survival there was no significant difference between the both groups; (4) Conclusions: reconstructive vulvar surgery enables enhanced complete resection rates of larger vulvar tumors with better anatomical restoration and a comparable wound recovery in comparison to primary closure. This results in a lower recurrence rate despite the increased tumor volume. Full article
(This article belongs to the Special Issue Management of Vulvar Cancer)
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12 pages, 2987 KiB  
Article
Lymphatic Function of the Lower Limb after Groin Dissection for Vulvar Cancer and Reconstruction with Lymphatic SCIP Flap
by Anna Amelia Caretto, Gianluigi Stefanizzi, Simona Maria Fragomeni, Alex Federico, Luca Tagliaferri, Valentina Lancellotta, Giovanni Scambia and Stefano Gentileschi
Cancers 2022, 14(4), 1076; https://doi.org/10.3390/cancers14041076 - 21 Feb 2022
Cited by 8 | Viewed by 13890
Abstract
Inguinofemoral lymphadenectomy, frequently performed for vulvar cancer, is burdened with substantial immediate and long-term morbidity. One of the most disabling treatment-related sequelae is lower limb lymphedema (LLL). The present study aims to describe the wound complications and the severity of LLL in patients [...] Read more.
Inguinofemoral lymphadenectomy, frequently performed for vulvar cancer, is burdened with substantial immediate and long-term morbidity. One of the most disabling treatment-related sequelae is lower limb lymphedema (LLL). The present study aims to describe the wound complications and the severity of LLL in patients who have undergone groin dissection for vulvar cancer and immediate inguinal reconstruction with the Lymphatic Superficial Circumflex Iliac Perforator flap (L-SCIP). We retrospectively reviewed the data of patients who underwent bilateral groin dissection and unilateral inguinal reconstruction with the L-SCIP. The presence and severity of postoperative LLL during the follow-up period were assessed by lymphoscintigraphy and limbs’ volume measurement. In addition, immediate complications at the level of the inguinal area were registered. The changes between preoperative and postoperative limb volumes were analyzed by Student’s t test. p values < 0.05 were considered significant. Thirty-one patients were included. The mean variation of volume was 479 ± 330 cc3 in the side where groin reconstruction had been performed, and 683 ± 425 cc3 in the contralateral side, showing smaller variation in the treated side (p = 0.022). Lymphoscintigraphy confirmed the clinical findings. Based on our results, inguinal reconstruction with L-SCIP performed at the same time of groin dissection in patients treated for vulvar cancer can provide a significant protective effect on LLL. Full article
(This article belongs to the Special Issue Management of Vulvar Cancer)
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9 pages, 809 KiB  
Article
Medial Inguino-Femoral Lymphadenectomy for Vulvar Cancer: An Approach to Decrease Lymphedema without Compromising Survival
by Neville F. Hacker, Ellen Barlow, Stephen Morrell and Katrina Tang
Cancers 2021, 13(22), 5806; https://doi.org/10.3390/cancers13225806 - 19 Nov 2021
Viewed by 1602
Abstract
Background: Lower limb lymphedema is a long-term complication of inguino-femoral lymphadenectomy and is related to the number of lymph nodes removed. Our hypothesis was that lymph nodes lateral to the femoral artery could be left in situ if the medial nodes were negative, [...] Read more.
Background: Lower limb lymphedema is a long-term complication of inguino-femoral lymphadenectomy and is related to the number of lymph nodes removed. Our hypothesis was that lymph nodes lateral to the femoral artery could be left in situ if the medial nodes were negative, thereby decreasing this risk. Methods: We included patients with vulvar cancer of any histological type, even if the cancer extended medially to involve the urethra, anus, or vagina. We excluded patients whose tumor extended (i) laterally onto the thigh, (ii) posteriorly onto the buttocks, or (iii) anteriorly onto the mons pubis. After resection, the inguinal nodes were divided into a medial and a lateral group, based on the lateral border of the femoral artery. Results: Between December 2010 and July 2018, 76 patients underwent some form of groin node dissection, and data were obtained from 112 groins. Approximately one-third of nodes were located lateral to the femoral artery. Positive groin nodes were found in 29 patients (38.2%). All patients with positive nodes had positive nodes medial to the femoral artery. Five patients (6.6%) had positive lateral inguinal nodes. The probability of having a positive lateral node given a negative medial node was estimated to be 0.00002. Conclusion: Provided the medial nodes are negative, medial inguino-femoral lymphadenectomy may suffice and should reduce lower limb lymphedema without compromising survival. Full article
(This article belongs to the Special Issue Management of Vulvar Cancer)
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13 pages, 742 KiB  
Article
Superficially Invasive Vulvar Squamous Cell Carcinoma: A 37-Year-Long Experience of a Tertiary Referral Center
by Mario Preti, Fulvio Borella, Niccolò Gallio, Luca Bertero, Debra Sandra Heller, Pedro Vieira-Baptista, Stefano Cosma, Federica Bevilacqua, Sebastiana Privitera, Leonardo Micheletti and Chiara Benedetto
Cancers 2021, 13(15), 3859; https://doi.org/10.3390/cancers13153859 - 31 Jul 2021
Cited by 4 | Viewed by 2613
Abstract
Superficially, invasive vulvar squamous cell carcinoma (SISCCA) (FIGO stage IA) is a rare subset of vulvar cancer defined as a single lesion measuring ≤2 cm with a depth of invasion of ≤1.0 mm. This is a retrospective study performed on 48 patients with [...] Read more.
Superficially, invasive vulvar squamous cell carcinoma (SISCCA) (FIGO stage IA) is a rare subset of vulvar cancer defined as a single lesion measuring ≤2 cm with a depth of invasion of ≤1.0 mm. This is a retrospective study performed on 48 patients with SISCCA, surgically treated between 1981 and 2018 at the S. Anna Hospital, University of Turin, to evaluate pathological characteristics and prognosis of these tumors. Ten patients (21%) recurred: seven (14%) as SISCCA and three (7%) as deeply invasive carcinoma. One case with perineural invasion and groin node metastasis at recurrence. No patient had groin lymph node metastases at initial diagnosis. Site of SISCCA, type of surgery, status of surgical margins, and histopathological features did not differ between recurrent and non-recurrent patients. We observed a non-significant trend towards an increase of recurrences in younger women (median age: 63 years vs. 70 years, p = 0.09), while, surprisingly, smaller tumors (<12 mm) were significantly related to tumor relapse (p = 0.03). Overall, SISCCA has a good long-term prognosis, regardless of the pathological characteristics and the type of surgical treatment. We recommend close follow-up, especially for younger patients and for small tumors, due to the possibility of recurrence or re-occurrence even after years. Full article
(This article belongs to the Special Issue Management of Vulvar Cancer)
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11 pages, 1315 KiB  
Article
Quality of Life with Vulvar Carcinoma Treated with Palliative Electrochemotherapy: The ELECHTRA (ELEctroCHemoTherapy vulvaR cAncer) Study
by Anna Myriam Perrone, Martina Ferioli, Lisa Argnani, Francesca De Terlizzi, Cecilia Pirovano, Piero Covarelli, Giulia Dondi, Marco Tesei, Eugenia De Crescenzo, Gloria Ravegnini, Andrea Galuppi, Alessio G. Morganti and Pierandrea De Iaco
Cancers 2021, 13(7), 1622; https://doi.org/10.3390/cancers13071622 - 01 Apr 2021
Cited by 11 | Viewed by 2271
Abstract
The ELECHTRA (ELEctroChemoTherapy vulvaR cAncer) project was conceived to collect data on palliative electrochemotherapy (ECT) in vulvar cancer (VC) assessing patients’ outcomes (response and survival) and impact on quality of life (QoL). After reporting outcome data in 2019, here, we present the results [...] Read more.
The ELECHTRA (ELEctroChemoTherapy vulvaR cAncer) project was conceived to collect data on palliative electrochemotherapy (ECT) in vulvar cancer (VC) assessing patients’ outcomes (response and survival) and impact on quality of life (QoL). After reporting outcome data in 2019, here, we present the results on QoL. A multicenter prospective observational study was conducted on patients with VC refractory or not amenable to standard therapies undergoing palliative ECT as per clinical practice. The following questionnaires were administered before and after ECT (two and four months later, early and late follow-up): visual analog pain scale (VAS), EuroQol 5-Dimension 5-Level (EQ-5D-L5) and Functional Assessment of Cancer Therapy—Vulva cancer (FACT—V). Analyses were conducted on both the whole study population and by subgroups (clinical response after ECT and site, number and size of lesions). Questionnaires from 55 patients were evaluated. Compared to the baseline (6.1 ± 2.1), the VAS was significantly reduced at early (4.3 ± 2.5) and late follow-up (4.6 ± 2.8) (p < 0.0001). The FACT—V score improved significantly at early (9.6 ± 4.0) (p < 0.0001) and late follow-up (8.9 ± 4.1) (p < 0.0054) as compared to the baseline (7.1 ± 3.6). No EQ-5D-5L statistically significant changes were observed. Subgroup analyses showed worse QoL in patients with stable or progressive disease, posterior site and multiple or larger than 3 cm nodules. This is the first study reporting improved QoL in VC patients after palliative ECT. Based on these results, ECT in VC should be considered an effective option based on the favorable outcomes both in terms of response and QoL. Full article
(This article belongs to the Special Issue Management of Vulvar Cancer)
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Review

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24 pages, 2786 KiB  
Review
Management of Early-Stage Vulvar Cancer
by Priscila Grecca Pedrão, Yasmin Medeiros Guimarães, Luani Rezende Godoy, Júlio César Possati-Resende, Adriane Cristina Bovo, Carlos Eduardo Mattos Cunha Andrade, Adhemar Longatto-Filho and Ricardo dos Reis
Cancers 2022, 14(17), 4184; https://doi.org/10.3390/cancers14174184 - 29 Aug 2022
Cited by 6 | Viewed by 6500
Abstract
Vulvar cancer is a rare gynecological malignancy since it represents 4% of all cancers of the female genital tract. The most common histological type is squamous cell carcinoma (90%). This type can be classified into two clinicopathological subtypes according to the etiology. The [...] Read more.
Vulvar cancer is a rare gynecological malignancy since it represents 4% of all cancers of the female genital tract. The most common histological type is squamous cell carcinoma (90%). This type can be classified into two clinicopathological subtypes according to the etiology. The first subtype is associated with persistent human papillomavirus infection and is usually diagnosed in younger women. The second subtype is associated with lichen sclerosus condition, and in most cases is diagnosed in postmenopausal women. Currently, an increase in first subtype cases has been observed, which raised the concern about associated mortality and treatment morbidity among young women. Vulvar cancer treatment depends on histopathology grade and staging, but surgery with or without radiotherapy as adjuvant treatment is considered the gold standard. In recent decades, sentinel lymph node biopsy has been incorporated as part of the treatment. Therefore, we sought to review and discuss the advances documented in the literature about vulvar cancer focusing on the treatment of early-stage disease. Relevant articles, such as the GROINS-V studies and the GOG protocols, are presented in this review. Additionally, we discuss key points such as the evolution of treatment from invasive surgery with high morbidity, to more conservative approaches without compromising oncologic safety; the role of sentinel lymph node mapping in the initial staging, since it reduces the complications caused by inguinofemoral lymphadenectomy; the recurrences rates, since local recurrence is common and curable, however, groin-associated, or distant recurrences have a poor prognosis; and, finally, the long-term follow-up that is essential for all patients. Full article
(This article belongs to the Special Issue Management of Vulvar Cancer)
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10 pages, 518 KiB  
Review
History and Updates of the GROINSS-V Studies
by Marise M. Wagner, Ate G. J. van der Zee and Maaike H. M. Oonk
Cancers 2022, 14(8), 1956; https://doi.org/10.3390/cancers14081956 - 13 Apr 2022
Cited by 8 | Viewed by 1850
Abstract
Surgical management of vulvar cancer is associated with high morbidity rates. The main aim of the GROINSS-V studies is reducing treatment-related morbidity by finding safe alternative treatment options in early-stage vulvar cancer patients. This article reviews the history, results, and updates of the [...] Read more.
Surgical management of vulvar cancer is associated with high morbidity rates. The main aim of the GROINSS-V studies is reducing treatment-related morbidity by finding safe alternative treatment options in early-stage vulvar cancer patients. This article reviews the history, results, and updates of the GROINSS-V studies. The first GROINSS-V study was a multicenter observational study (from 2000 to 2006), which investigated the safety and clinical applicability of the sentinel lymph node procedure in patients with early-stage vulvar cancer. GROINSS-V-I showed that omitting inguinofemoral lymphadenectomy was safe in early-stage vulvar cancer patients with a negative sentinel lymph node, with an impressive reduction in treatment-related morbidity. GROINSS-V-II, a prospective multicenter phase II single-arm treatment trial (from 2005 to 2016) investigated whether radiotherapy could be a safe alternative for inguinofemoral lymphadenectomy in patients with a metastatic sentinel lymph node. This study showed that radiotherapy in patients with sentinel lymph node micrometastases (≤2 mm) was safe in terms of groin recurrence rate and with less treatment-related morbidity. These results, published in August 2021, should be implemented in (inter)national treatment guidelines for vulvar cancer. GROINSS-V-III recently started including patients. This study investigates the effectiveness and safety of chemoradiation in patients with a macrometastasis (>2 mm) in the sentinel lymph node. Full article
(This article belongs to the Special Issue Management of Vulvar Cancer)
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14 pages, 499 KiB  
Review
The Radiotherapy Role in the Multidisciplinary Management of Locally Advanced Vulvar Cancer: A Multidisciplinary VulCan Team Review
by Luca Tagliaferri, Valentina Lancellotta, Calogero Casà, Simona Maria Fragomeni, Martina Ferioli, Stefano Gentileschi, Anna Amelia Caretto, Giacomo Corrado, Benedetta Gui, Giuseppe Ferdinando Colloca, Maria Antonietta Gambacorta, Alessio Giuseppe Morganti, Giorgia Garganese and Gabriella Macchia
Cancers 2021, 13(22), 5747; https://doi.org/10.3390/cancers13225747 - 17 Nov 2021
Cited by 17 | Viewed by 2509
Abstract
Locally advanced vulvar cancer (LAVC) is a challenging disease, requiring multidisciplinary management. The aim of this review is to propose an integrated clinical approach including radiotherapy (RT) in the multidisciplinary management of LAVC to customize the treatment. A review of the literature was [...] Read more.
Locally advanced vulvar cancer (LAVC) is a challenging disease, requiring multidisciplinary management. The aim of this review is to propose an integrated clinical approach including radiotherapy (RT) in the multidisciplinary management of LAVC to customize the treatment. A review of the literature was conducted on PubMed, Scopus, and Cochrane library to acquire all relevant studies on RT in LAVC. Based on the available evidence, RT, with or without concurrent chemotherapy, has a relevant role as adjuvant and exclusive treatment or in the neoadjuvant setting. However, multicentric prospective trials are needed to define the best treatment options based on tumor and patient characteristics. A multidisciplinary and multidimensional assessment can also be useful to identify the most suitable approach, considering patients’ age and comorbidities, in view of a better treatment personalization. Full article
(This article belongs to the Special Issue Management of Vulvar Cancer)
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16 pages, 557 KiB  
Review
Role of Chemotherapy in Vulvar Cancers: Time to Rethink Standard of Care?
by Marco Mazzotta, Laura Pizzuti, Eriseld Krasniqi, Francesca Sofia Di Lisa, Federico Cappuzzo, Lorenza Landi, Domenico Sergi, Fabio Pelle, Sonia Cappelli, Claudio Botti, Enrico Vizza, Silverio Tomao, Luca Marchetti, Giuseppe Sanguineti, Andrea Botticelli, Paolo Marchetti, Valentina Magri, Simona Pisegna, Aldo Venuti, Federica Tomao, Federica Buzzacchino, Gennaro Ciliberto, Maddalena Barba and Patrizia Viciadd Show full author list remove Hide full author list
Cancers 2021, 13(16), 4061; https://doi.org/10.3390/cancers13164061 - 12 Aug 2021
Cited by 6 | Viewed by 6232
Abstract
The actual role of chemotherapy in vulvar cancer is undeniably a niche topic. The low incidence of the disease limits the feasibility of randomized trials. Decision making is thus oriented by clinical and pathological features, whose relevance is generally weighted against evidence from [...] Read more.
The actual role of chemotherapy in vulvar cancer is undeniably a niche topic. The low incidence of the disease limits the feasibility of randomized trials. Decision making is thus oriented by clinical and pathological features, whose relevance is generally weighted against evidence from observational studies and clinical practice. The therapeutic management of vulvar cancer is increasingly codified and refined at an individual patient level. It is of note that the attitude towards evidence sharing and discussion within a multidisciplinary frame is progressively consolidating. Viable options included in the therapeutic armamentarium available for vulvar cancer patients are frequently an adaption from standards used for cervical or anal carcinoma. Chemotherapy is more frequently combined with radiotherapy as neo-/adjuvant or definitive treatment. Drugs commonly used are platinum derivative, 5-fluorouracil and mitomicin C, mostly in combination with radiotherapy for radiosensitization. Exclusive chemotherapy in the neo-/adjuvant setting comprises platinum-derivative, combined with bleomicin and methotrexate, 5-fluorouracil, ifosfamide or taxanes. In advanced disease, current regimens include cisplatin-based chemoradiation, with or without 5-fluorouracil, or doublets with platinum in combination with a taxane. Our work is also enriched by a concise excursus on the biologic pathways underlying vulvar cancer. Introductory hints are also provided on targeted agents, a rapidly evolving research field. Full article
(This article belongs to the Special Issue Management of Vulvar Cancer)
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Other

14 pages, 2254 KiB  
Systematic Review
The Role of Ultrasound in the Evaluation of Inguinal Lymph Nodes in Patients with Vulvar Cancer: A Systematic Review and Meta-Analysis
by Debora Verri, Francesca Moro, Simona Maria Fragomeni, Drieda Zaçe, Sonia Bove, Federica Pozzati, Benedetta Gui, Giovanni Scambia, Antonia Carla Testa and Giorgia Garganese
Cancers 2022, 14(13), 3082; https://doi.org/10.3390/cancers14133082 - 23 Jun 2022
Cited by 10 | Viewed by 1889
Abstract
Objective. To determine the efficacy of ultrasound in assessing the inguinal lymph nodes in patients with vulvar cancer. Methods. A systematic review of published research up to October 2020 that compares the results of ultrasound to determine groin node status with histology was [...] Read more.
Objective. To determine the efficacy of ultrasound in assessing the inguinal lymph nodes in patients with vulvar cancer. Methods. A systematic review of published research up to October 2020 that compares the results of ultrasound to determine groin node status with histology was conducted. All study types that reported primary data on the role of ultrasound in the evaluation of groin lymph nodes in vulvar cancer were included in the systematic review. Data retrieved from the included studies were pooled in random-effects meta-analyses. Results. After the screening and selection process, eight articles were deemed pertinent for inclusion in the systematic review and meta-analysis. The random-effects model showed a pooled Se of 0.85 (95% CI: 0.81–0.89), Sp of 0.86 (95% CI: 0.81–0.91), PPV of 0.65 (95% CI: 0.54–0.79) and NPV of 0.92 (95% CI: 0.91–0.94). There was a pooled LR+ and LR− of 6.44 (95% CI: 3.72–11.4) and 0.20 (95% CI: 0.14–0.27), respectively. The pooled accuracy was 0.85 (95% CI: 0.80–0.91). Conclusions. Although the studies had small sample sizes, this review represents the best summary of the data so far. Ultrasound has revealed high sensitivity and high negative predictive value in the assessment of nodal status in vulvar cancer. Full article
(This article belongs to the Special Issue Management of Vulvar Cancer)
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17 pages, 2094 KiB  
Systematic Review
Electrochemotherapy in Vulvar Cancer and Cisplatin Combined with Electroporation. Systematic Review and In Vitro Studies
by Anna Myriam Perrone, Gloria Ravegnini, Stefano Miglietta, Lisa Argnani, Martina Ferioli, Eugenia De Crescenzo, Marco Tesei, Marco Di Stanislao, Giulia Girolimetti, Giuseppe Gasparre, Anna Maria Porcelli, Francesca De Terlizzi, Claudio Zamagni, Alessio Giuseppe Morganti and Pierandrea De Iaco
Cancers 2021, 13(9), 1993; https://doi.org/10.3390/cancers13091993 - 21 Apr 2021
Cited by 9 | Viewed by 2532
Abstract
Electrochemotherapy (ECT) is an emerging treatment for solid tumors and an attractive research field due to its clinical results. This therapy represents an alternative local treatment to the standard ones and is based on the tumor-directed delivery of non-ablative electrical pulses to maximize [...] Read more.
Electrochemotherapy (ECT) is an emerging treatment for solid tumors and an attractive research field due to its clinical results. This therapy represents an alternative local treatment to the standard ones and is based on the tumor-directed delivery of non-ablative electrical pulses to maximize the action of specific cytotoxic drugs such as cisplatin (CSP) and bleomycin (BLM) and to promote cancer cell death. Nowadays, ECT is mainly recommended as palliative treatment. However, it can be applied to a wide range of superficial cancers, having an impact in preventing or delaying tumor progression and therefore in improving quality of life. In addition, during the natural history of the tumor, early ECT may improve patient outcomes. Our group has extensive clinical and research experience on ECT in vulvar tumors in the palliative setting, with 70% overall response rate. So far, in most studies, ECT was based on BLM. However, the potential of CSP in this setting seems interesting due to some theoretical advantages. The purpose of this report is to: (i) compare the efficacy of CSP and BLM-based ECT through a systematic literature review; (ii) report the results of our studies on CSP-resistant squamous cell tumors cell lines and the possibility to overcome chemoresistance using ECT; (iii) discuss the future ECT role in gynecological tumors and in particular in vulvar carcinoma. Full article
(This article belongs to the Special Issue Management of Vulvar Cancer)
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