Pelvic Lymphadenectomy in Vulvar Cancer - Does it make sense?
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Pelvic Lymphadenectomy in Vulvar Cancer - Does it make sense? / Woelber, Linn; Bommert, Mareike; Prieske, Katharina; Fischer, Inger; Zu Eulenburg, Christine; Vettorazzi, Eik; Harter, Philipp; Jueckstock, Julia; Hilpert, Felix; de Gregorio, Niko; Iborra, Severine; Sehouli, Jalid; Ignatov, Atanas; Hillemanns, Peter; Fuerst, Sophie; Strauss, Hans-Georg; Baumann, Klaus; Beckmann, Matthias; Mustea, Alexander; Meier, Werner; Wimberger, Pauline; Hanker, Lars; Canzler, Ulrich; Fehm, Tanja; Luyten, Alexander; Hellriegel, Martin; Kosse, Jens; Heiss, Christoph; Hantschmann, Peer; Mallmann, Peter; Tanner, Berno; Pfisterer, Jacobus; Mahner, Sven; Schmalfeldt, Barbara; Jaeger, Anna.
in: GEBURTSH FRAUENHEILK, Jahrgang 80, Nr. 12, 12.2020, S. 1221-1228.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Pelvic Lymphadenectomy in Vulvar Cancer - Does it make sense?
AU - Woelber, Linn
AU - Bommert, Mareike
AU - Prieske, Katharina
AU - Fischer, Inger
AU - Zu Eulenburg, Christine
AU - Vettorazzi, Eik
AU - Harter, Philipp
AU - Jueckstock, Julia
AU - Hilpert, Felix
AU - de Gregorio, Niko
AU - Iborra, Severine
AU - Sehouli, Jalid
AU - Ignatov, Atanas
AU - Hillemanns, Peter
AU - Fuerst, Sophie
AU - Strauss, Hans-Georg
AU - Baumann, Klaus
AU - Beckmann, Matthias
AU - Mustea, Alexander
AU - Meier, Werner
AU - Wimberger, Pauline
AU - Hanker, Lars
AU - Canzler, Ulrich
AU - Fehm, Tanja
AU - Luyten, Alexander
AU - Hellriegel, Martin
AU - Kosse, Jens
AU - Heiss, Christoph
AU - Hantschmann, Peer
AU - Mallmann, Peter
AU - Tanner, Berno
AU - Pfisterer, Jacobus
AU - Mahner, Sven
AU - Schmalfeldt, Barbara
AU - Jaeger, Anna
N1 - The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
PY - 2020/12
Y1 - 2020/12
N2 - Since the publication of the updated German guideline in 2015, the recommendations for performing pelvic lymphadenectomy (LAE) in patients with vulvar cancer (VSCC) have changed considerably. The guideline recommends surgical lymph node staging in all patients with a higher risk of pelvic lymph node involvement. However, the current data do not allow the population at risk to be clearly defined, therefore, the indication for pelvic lymphadenectomy is still not clear. There are currently two published German patient populations who had pelvic LAE which can be used to investigate both the prognostic effect of histologically verified pelvic lymph node metastasis and the relation between inguinal and pelvic lymph node involvement. A total of 1618 patients with primary FIGO stage ≥ IB VSCC were included in the multicenter AGO CaRE-1 study (1998 - 2008), 70 of whom underwent pelvic LAE. During a retrospective single-center evaluation carried out at the University Medical Center Hamburg-Eppendorf (UKE), a total of 514 patients with primary VSCC treated between 1996 - 2018 were evaluated, 21 of whom underwent pelvic LAE. In both cohorts, around 80% of the patients who underwent pelvic LAE were inguinally node-positive, with a median number of three affected groin lymph nodes. There were no cases of pelvic lymph node metastasis without inguinal lymph node metastasis in either of the two cohorts. Between 33 - 35% of the inguinal node-positive patients also had pelvic lymph node metastasis; the median number of affected groin lymph nodes in these patients was high (> 4), and the maximum median diameter of the largest inguinal metastasis was > 40 mm in both cohorts. Pelvic lymph node staging and pelvic radiotherapy is therefore probably not necessary for the majority of node-positive patients with VSCC, as the relevant risk of pelvic lymph node involvement was primarily found in node-positive patients with high-grade disease. More, ideally prospective data collections are necessary to validate the relation between inguinal and pelvic lymph node involvement.
AB - Since the publication of the updated German guideline in 2015, the recommendations for performing pelvic lymphadenectomy (LAE) in patients with vulvar cancer (VSCC) have changed considerably. The guideline recommends surgical lymph node staging in all patients with a higher risk of pelvic lymph node involvement. However, the current data do not allow the population at risk to be clearly defined, therefore, the indication for pelvic lymphadenectomy is still not clear. There are currently two published German patient populations who had pelvic LAE which can be used to investigate both the prognostic effect of histologically verified pelvic lymph node metastasis and the relation between inguinal and pelvic lymph node involvement. A total of 1618 patients with primary FIGO stage ≥ IB VSCC were included in the multicenter AGO CaRE-1 study (1998 - 2008), 70 of whom underwent pelvic LAE. During a retrospective single-center evaluation carried out at the University Medical Center Hamburg-Eppendorf (UKE), a total of 514 patients with primary VSCC treated between 1996 - 2018 were evaluated, 21 of whom underwent pelvic LAE. In both cohorts, around 80% of the patients who underwent pelvic LAE were inguinally node-positive, with a median number of three affected groin lymph nodes. There were no cases of pelvic lymph node metastasis without inguinal lymph node metastasis in either of the two cohorts. Between 33 - 35% of the inguinal node-positive patients also had pelvic lymph node metastasis; the median number of affected groin lymph nodes in these patients was high (> 4), and the maximum median diameter of the largest inguinal metastasis was > 40 mm in both cohorts. Pelvic lymph node staging and pelvic radiotherapy is therefore probably not necessary for the majority of node-positive patients with VSCC, as the relevant risk of pelvic lymph node involvement was primarily found in node-positive patients with high-grade disease. More, ideally prospective data collections are necessary to validate the relation between inguinal and pelvic lymph node involvement.
U2 - 10.1055/a-1120-0138
DO - 10.1055/a-1120-0138
M3 - SCORING: Journal article
C2 - 33293730
VL - 80
SP - 1221
EP - 1228
JO - GEBURTSH FRAUENHEILK
JF - GEBURTSH FRAUENHEILK
SN - 0016-5751
IS - 12
ER -