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

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

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

Gynecol Oncol. 2024 Dec:191:106-113. doi: 10.1016/j.ygyno.2024.10.005. Epub 2024 Oct 16.

Authors

Affiliations

¹ U.O.C. Ginecologia Oncologica, Dipartimento per le Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
² U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica Ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy.
³ U.O.C. Ginecologia Oncologica, Dipartimento per le Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy. Electronic address: [email protected].
⁴ Radiation Oncology Unit, Gemelli Molise Hospital - Università Cattolica del Sacro Cuore, Campobasso, Italy.
⁵ Research Core Facilty Data Collection G-STeP, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica Del Sacro Cuore, Rome, Italy.
⁶ U.O.C. Anatomia Patologica Generale, Dipartimento per le Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Istituto di Anatomia Patologica, Università Cattolica del Sacro Cuore, Rome, Italy.
⁷ U.O.C. Anatomia Patologica Generale, Dipartimento per le Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
⁸ U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica Ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy.
⁹ U.O.C. Ginecologia Oncologica, Dipartimento per le Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Dipartimento Universitario Scienze della Vita e Sanità Pubblica - Sezione di Ginecologia ed Ostetricia - Università Cattolica del Sacro Cuore, Rome, Italy.
¹⁰ Unità Operativa di Chirurgia dei Genitali Esterni Femminili, Divisione di Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Gemelli Women Health Center for Digital and Personalized Medicine, Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy.

PMID: 39413556
DOI: 10.1016/j.ygyno.2024.10.005

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.

Keywords: Chemoradiation in vulvar cancer; HPV-status in vulvar cancer; Locally advanced vulvar cancer; Radiotherapy in vulvar cancer; Squamous cell vulvar cancer; Surgery after chemoradiation in vulvar cancer; Surgery-related toxicity in vulvar cancer.

MeSH terms

Adult
Aged
Aged, 80 and over
Carcinoma, Squamous Cell* / mortality
Carcinoma, Squamous Cell* / pathology
Carcinoma, Squamous Cell* / therapy
Chemoradiotherapy* / methods
Cyclin-Dependent Kinase Inhibitor p16 / analysis
Cyclin-Dependent Kinase Inhibitor p16 / metabolism
Female
Humans
Middle Aged
Neoplasm Staging
Neoplasm, Residual
Retrospective Studies
Survival Rate
Treatment Outcome
Vulvar Neoplasms* / mortality
Vulvar Neoplasms* / pathology
Vulvar Neoplasms* / therapy

Substances

Cyclin-Dependent Kinase Inhibitor p16