Chi_Principles and Practice of Gynecologic Oncology 8e

28 SECTION 2 ■ Vulvar Cancer

83. Damast S, Jeffery DD, Son CH, et al. Literature review of vagi nal stenosis and dilator use in radiation oncology. Pract Radiat Oncol . 2019;9:479-491. 84. Geisler JP, Manahan KJ, Buller RE. Neoadjuvant chemother apy in vulvar cancer: avoiding primary exenteration. Gynecol Oncol . 2006;100(1):53-57. 85. Raspagliesi F, Zanaboni F, Martinelli F, et al. Role of paclitaxel and cisplatin as the neoadjuvant treatment for locally advanced squamous cell carcinoma of the vulva. J Gynecol Oncol . 2014;25(1):22-29. 86. Aragona AM, Cuneo N, Soderini AH, et al. Tailoring the treatment of locally advanced squamous cell carcinoma of the vulva: neoadjuvant che motherapy followed by radical surgery: results from a multicenter study. Int J Gynecol Cancer . 2012;22(7):1258-1263. 87. Witteveen PO, van der Velden J, Vergote I, et al. Phase II study on paclitaxel in patients with recurrent, metastatic or locally advanced vulvar cancer not amenable to surgery or radiotherapy: a study of the EORTC-GCG (European Organisation for Research and Treatment of Cancer–Gynaecological Cancer Group). Ann Oncol . 2009;20(9):1511-1516. 88. Thigpen JT, Blessing JA, Homesley HD, et al. Phase II trials of cis platin and piperazinedione in advanced or recurrent squamous cell carci noma of the vulva: a Gynecologic Oncology Group study. Gynecol Oncol . 1986;23(3):358-363. 89. Muss HB, Bundy BN, Christopherson WA. Mitoxantrone in the treat ment of advanced vulvar and vaginal carcinoma: a Gynecologic Oncology Group study. Am J Clin Oncol . 1989;12(2):142-144. 90. Cormio G, Loizzi V, Gissi F, et al. Cisplatin and vinorelbine chemo therapy in recurrent vulvar carcinoma. Oncology . 2009;77(5):281-284. 91. Horowitz NS, Olawaiye AB, Borger DR, et al. Phase II trial of erlo tinib in women with squamous cell carcinoma of the vulva. Gynecol Oncol . 2012;127(1):141-146. 92. Olawaiye A, Lee LM, Krasner C, et al. Treatment of squamous cell vul var cancer with the anti-EGFR tyrosine kinase inhibitor Tarceva. Gynecol Oncol . 2007;106(3):628-630. 93. Bacha OM, Levesque E, Renaud MC, et al. A case of recurrent vulvar carcinoma treated with erlotinib, an EGFR inhibitor. Eur J Gynaecol Oncol . 2011;32(4):423-424. 94. Tewari KS, Sill MW, Long HJ III, et al. Improved survival with beva cizumab in advanced cervical cancer. N Engl J Med . 2014;370(8):734-743. 95. Zarei S, Voss JS, Jin L, et al. Mutational profile in vulvar, vaginal, and urethral melanomas: review of 37 cases with focus on primary tumor site. Int J Gynecol Pathol . 2020;39(6):587-594. 96. Naumann RW, Hollebecque A, Meyer T, et al. Safety and efficacy of nivolumab monotherapy in recurrent or metastatic cervical, vaginal, or vul var carcinoma: results from the phase I/II checkmate 358 trial. J Clin Oncol . 2019;37(31):2825-2834. 97. Yeku O, Russo AL, Lee H, et al. A phase 2 study of combined chemo-immunotherapy with cisplatin-pembrolizumab and radiation for unresectable vulvar squamous cell carcinoma. J Transl Med . 2020;18(1):350. 98. Ott PA, Bang YJ, Piha-Paul SA, et al. T-cell-inflamed gene-expression profile, programmed death ligand 1 expression, and tumor mutational bur den predict efficacy in patients treated with pembrolizumab across 20 can cers: KEYNOTE-028. J Clin Oncol . 2019;37(4):318-327.

68. Hoffman M, Greenberg S, Greenberg H, et al. Interstitial radiotherapy for the treatment of advanced or recurrent vulvar and distal vaginal malig nancy. Am J Obstet Gynecol . 1990;162(5):1278-1282. 69. Tewari K, Cappuccini F, Syed AM, et al. Interstitial brachytherapy in the treatment of advanced and recurrent vulvar cancer. Am J Obstet Gynecol . 1999;181(1):91-98. 70. Gaffney DK, King B, Viswanathan AN, et al. Consensus recommenda tions for radiation therapy contouring and treatment of vulvar carcinoma. Int J Radiat Oncol Biol Phys . 2016;95:1191-1200. 71. Kim CH, Olson AC, Kim H, et al. Contouring inguinal and femoral nodes; how much margin is needed around the vessels? Pract Radiat Oncol . 2012;2(4):274-278. 72. Dyer BA, Jenshus A, Mayadev JS. Integrated skin flash planning tech nique for intensity-modulated radiation therapy for vulvar cancer prevents marginal misses and improves superficial dose coverage. Med Dosim . 2019;44:7-10. 73. Kachnic LA, Winter K, Myerson RJ, et al. RTOG 0529: a phase 2 evaluation of dose-painted intensity modulated radiation therapy in com bination with 5-fluorouracil and mitomycin-C for the reduction of acute morbidity in carcinoma of the anal canal. Int J Radiat Oncol Biol Phys . 2013;86(1):27-33. 74. Klopp AH, Yeung AR, Deshmukh S, et al. Patient-reported toxicity during pelvic intensity-modulated radiation therapy: NRG Oncology-RTOG 1203. J Clin Oncol . 2018;36:2538-2544. 75. Chopra S, Gupta S, Kannan S, et al. Late toxicity after adjuvant con ventional radiation versus image-guided intensity-modulated radiotherapy for cervical cancer (PARCER): a randomized controlled trial. J Clin Oncol . 2021;39:3682-3692. 76. Klopp AH, Moughan J, Portelance L, et al. Hematologic toxicity in RTOG 0418: a phase 2 study of postoperative IMRT for gynecologic cancer. Int J Radiat Oncol Biol Phys . 2013;86(1):83-90. 77. Sapienza LG, Salcedo MP, Ning MS, et al. Pelvic insufficiency frac tures after external beam radiation therapy for gynecologic cancers: a meta-analysis and meta-regression of 3929 patients. Int J Radiat Oncol Biol Phys . 2020;106:475-484. 78. Carlson JW, Kauderer J, Hutson A, et al: GOG 244—the lymphedema and gynecologic cancer (LEG) study: incidence and risk factors in newly diagnosed patients. Gynecol Oncol . 2020;156:467-474. 79. Baxter NN, Habermann EB, Tepper JE, et al. Risk of pelvic frac tures in older women following pelvic irradiation. JAMA . 2005;294(20): 2587-2593. 80. Ikushima H, Osaki K, Furutani S, et al. Pelvic bone complications following radiation therapy of gynecologic malignancies: clinical evalu ation of radiation-induced pelvic insufficiency fractures. Gynecol Oncol . 2006;103(3):1100-1104. 81. Beriwal S, Heron DE, Kim H, et al. Intensity-modulated radiotherapy for the treatment of vulvar carcinoma: a comparative dosimetric study with early clinical outcome. Int J Radiat Oncol Biol Phys . 2006;64(5):1395-1400. 82. Barton DP. The prevention and management of treatment re lated morbidity in vulval cancer. Best Pract Res Clin Obstet Gynaecol . 2003;17(4):683-701.

Surgery for Vulvar Cancer 2.7 c h a p t e r

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Updated by Diane C. Ling and Sushil Beriwal

In planning a surgical approach, it is important to take into ac count the patient’s age, medical comorbidities, desire for sexual function preservation, tumor size, and disease stage. In the case of a locoregional vulvar cancer, surgery will remain the first choice of therapy (1).

Historical Background Development of the en bloc technique of radical vulvectomy with bilateral inguinofemoral lymphadenectomy during the 1940s and 1950s was a dramatic improvement over prior surgical options,