Treatment Outcomes of Vulvar Cancer: Our Experience From a Tertiary Care Center in Eastern India

Introduction: The vulva is the external genitalia in females. Vulvar carcinoma is a rare entity, with squamous cell carcinoma as the most common histology while basal cell carcinoma, extra-mammary Paget's disease, and melanoma are still rarer subtypes. Treatment often comprises a multidisciplinary approach with surgery being the mainstay, followed by adjuvant therapy, depending upon pathological stage and other factors. Neoadjuvant treatment is considered in locally advanced cases where upfront surgery would not achieve adequate margin or organ preservation (urethra and anal canal). Due to the rarity of the disease and initial presentation at advanced stages in third-world countries, it is important to have strict treatment protocols with identifications of various prognostic factors and regular timely follow-up, which would, in turn, improve treatment outcomes. Here, we are presenting our institutional retrospective cohort spanning over eight years.

Methods: This is a retrospective descriptive study done in the department of surgical oncology of a tertiary care cancer center in India from January 2016 to April 2024. A total of 21 patients with histologically proven diagnoses of vulvar cancer were included in the analysis. Stage of disease, treatment modalities used, and disease outcomes in terms of survival were tabulated. Statistical analysis was done using SPSS version 17 for Windows (SPSS Inc., Chicago, IL).

Results: The estimated five-year overall survival was ≈71% using Kaplan-Meier analysis. On univariate analysis (testing other factors), using a log-rank test, neither stage nor nodal positivity were significant prognostic factors for overall survival. Given the small number of cases, multivariate analysis was not possible.

Conclusion: In carcinoma of the vulva, treatment should be individualized with multidisciplinary cooperation. In many series, stage, nodal positivity, and extracapsular extension are found to be significant prognostic factors, though our results did not correspond with these data probably due to a small cohort. The paucity of data, especially from India and other developing countries, necessitates the need for more studies, preferably multicentric, keeping in mind the low prevalence of disease.