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When the sentinel node in the groin held only a tiny deposit of vulvar cancer, radiotherapy to the groin was a safe alternative to removing all the nodes; when the deposit was larger, radiotherapy alone was not enough.
Prospective multicentre phase 2 study of 1,535 women with early vulvar squamous cell carcinoma who had a sentinel node procedure; those with a positive node received inguinofemoral radiotherapy (50 Gy) instead of lymphadenectomy.
Among women with micrometastases (2 mm or less), the isolated groin recurrence rate at two years was about 1.6 percent with radiotherapy. Among those with macrometastases (over 2 mm), recurrence with radiotherapy alone was unacceptably high (about 22 percent), a stopping rule was triggered and lymphadenectomy was reinstated for that group.
The size of the deposit in the sentinel node now decides treatment: radiotherapy for micrometastases, full groin dissection (with or without chemoradiotherapy) for macrometastases.
Shares HPV-independent vulvar squamous cell carcinoma (p53-mutant), HPV-associated vulvar squamous cell carcinoma, Journal of Clinical Oncology.
Shares HPV-independent vulvar squamous cell carcinoma (p53-mutant), HPV-associated vulvar squamous cell carcinoma.
Shares HPV-independent vulvar squamous cell carcinoma (p53-mutant), HPV-associated vulvar squamous cell carcinoma.
Shares HPV-independent vulvar squamous cell carcinoma (p53-mutant), HPV-associated vulvar squamous cell carcinoma.
Shares HPV-independent vulvar squamous cell carcinoma (p53-mutant), HPV-associated vulvar squamous cell carcinoma.
Shares HPV-independent vulvar squamous cell carcinoma (p53-mutant), HPV-associated vulvar squamous cell carcinoma.
Shares HPV-independent vulvar squamous cell carcinoma (p53-mutant), HPV-associated vulvar squamous cell carcinoma.
Shares HPV-independent vulvar squamous cell carcinoma (p53-mutant), HPV-associated vulvar squamous cell carcinoma.