Retrospective cohort study of neoadjuvant chemotherapy followed by tailored surgery in locally advanced sphincter-threatening vulval cancer : an alternative to exenteration?

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Baillie, Kelly and Reed, Nicholas and Pan, Jiafeng and Laskey, Jennifer and Bennie, Marion and Crearie, Christine and Mueller, Tanja and Kavanagh, Kimberley and Siddiqui, Nadeem and Burton, Kevin and Telfer, John and Lindsay, Rhona and Shanbhag, Smruta and Harrand, Rosie and Sadozye, Azmat and Graham, Kathryn (2021) Retrospective cohort study of neoadjuvant chemotherapy followed by tailored surgery in locally advanced sphincter-threatening vulval cancer : an alternative to exenteration? European Journal of Gynaecological Oncology, 42 (5). pp. 917-925. ISSN 0392-2936 (https://doi.org/10.31083/j.ejgo4205139)

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Abstract

Objective: To determine the feasibility and overall survival (OS) outcome of utilizing neoadjuvant chemotherapy (NACT) followed by wide local excision (WLE) in women with sphincter-threatening locally advanced squamous cell carcinoma (SCC) of the vulva. Methods: The electronic chemotherapy prescribing system was used to identify patients from the West of Scotland Cancer Network (WoSCAN) who received NACT over a 5 year period, January 2012 to December 2016 inclusive. Baseline characteristics and treatment details were collected. Association of treatment type and other variables with OS were analysed using Cox proportional hazards model. Results: 57 patients with newly diagnosed SCC of the vulva were identified; recurrences were excluded. 25 patients proceeded to WLE following NACT. No permanent stomas were required. 4% of patients had a complete response with NACT alone, not undergoing surgery, and remained disease free at the study end. OS was 39.3 months (95% Confidence Interval (CI) 32.5 – Not reached (NR)) for the entire cohort and 40.1 months (95% CI 39.3 – NR) in the surgical group following median follow up of 27 months. Local recurrence was the predominant cause of failure. Conclusions: NACT followed by WLE is effective in a subgroup of patients with locally advanced vulval cancer and can minimize the extent of surgery necessary, but close monitoring is required to identify and manage relapse early.

ORCID iDs

Baillie, Kelly, Reed, Nicholas, Pan, Jiafeng ORCID logoORCID: https://orcid.org/0000-0001-5993-3209, Laskey, Jennifer, Bennie, Marion ORCID logoORCID: https://orcid.org/0000-0002-4046-629X, Crearie, Christine, Mueller, Tanja ORCID logoORCID: https://orcid.org/0000-0002-0418-4789, Kavanagh, Kimberley ORCID logoORCID: https://orcid.org/0000-0002-2679-5409, Siddiqui, Nadeem, Burton, Kevin, Telfer, John, Lindsay, Rhona, Shanbhag, Smruta, Harrand, Rosie, Sadozye, Azmat and Graham, Kathryn;
CORE (COnnecting REpositories)