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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 iden-tify 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. [ABSTRACT FROM AUTHOR]

Objective: To evaluate factors associated with an increased risk of local recurrence of squamous cell carcinoma (SCCA) of the vulva. Materials and Methods: Sixty-seven pathologic specimens of vulvar SCCA from 1991-2010 were retrospectively reviewed by a gynecologic pathologist. Medical records were reviewed for demographic, treatment, disease, and follow-up information. Risk of local recurrence was analyzed using Wilcoxon rank sum test and Fisher's analysis. Recurrence-free survival (RFS) was calculated with the Log Rank test and Cox regression. Results: Stage distribution in the 67 patients was: four (6.0%) Stage IA, 48 (77.6%) Stage IB, three (4.5%) Stage II, 11 (16.4%) Stage III, and one (1.5%) Stage IV. Overall five-year survival was 84% and median RFS was 84.8 months. Thirty-seven percent of patients (25/67) presented with a local recurrence at their initial re-presentation after initial treatment, accounting for 92.6% of initial recurrences. Rates of local recurrence were lower in non-Caucasians (p = 0.047) and when carcinoma in situ was present at the margin (p = 0.03). RFS was not affected by stage (p = 0.60), lymph node status (p = 0.55), tumor size (p=0.45), or pathologic factors. In particular, tumor distance from the surgical margins as a continuous variable or at any cut-off was not associated with either risk of local recurrence or shortened recurrence-free survival; however, there was a trend between prolonged RFS with increasing disease-free pathologic margin (p = 0.09). Conclusion: Risk of local recurrence and RFS of vulvar SCCA following surgical excision were not affected significantly by most clinical or pathologic variables, including lymph node status, and disease-free margin size. [ABSTRACT FROM AUTHOR]