1. Unilateral inguinofemoral lymphadenectomy in patients with early-stage vulvar squamous cell carcinoma and a unilateral metastatic sentinel lymph node is safe.
- Author
-
Van der Kolk, W.L., Van der Zee, A.G.J., Slomovitz, B.M., Baldwin, P.J.W., Van Doorn, H.C., De Hullu, J.A., Van der Velden, J., Gaarenstroom, K.N., Slangen, B.F.M., Kjolhede, P., Brännström, M., Vergote, I., Holland, C.M., Coleman, R., Van Dorst, E.B.L., Van Driel, W.J., Nunns, D., Widschwendter, M., Nugent, D., and DiSilvestro, P.A.
- Subjects
- *
VULVAR cancer , *SENTINEL lymph nodes , *SENTINEL lymph node biopsy , *SQUAMOUS cell carcinoma , *LYMPHATIC metastasis , *LYMPHADENECTOMY , *METASTASIS - Abstract
• Contralateral groin metastases or recurrences in patients with unilateral SN metastasis are rare. • Unilateral groin treatment is sufficient in patients with unilateral SN metastases. • In near-midline vulvar cancer, unilateral SN detection is sufficient when the lymphoscintigram shows unilateral lymph flow. • These findings offer further opportunity to safely reduce treatment-related morbidity in early-stage vulvar cancer. Optimal management of the contralateral groin in patients with early-stage vulvar squamous cell carcinoma (VSCC) and a metastatic unilateral inguinal sentinel lymph node (SN) is unclear. We analyzed patients who participated in GROINSS-V I or II to determine whether treatment of the contralateral groin can safely be omitted in patients with a unilateral metastatic SN. We selected the patients with a unilateral metastatic SN from the GROINSS-V I and II databases. We determined the incidence of contralateral additional non-SN metastases in patients with unilateral SN-metastasis who underwent bilateral inguinofemoral lymphadenectomy (IFL). In those who underwent only ipsilateral groin treatment or no further treatment, we determined the incidence of contralateral groin recurrences during follow-up. Of 1912 patients with early-stage VSCC, 366 had a unilateral metastatic SN. Subsequently, 244 had an IFL or no treatment of the contralateral groin. In seven patients (7/244; 2.9% [95% CI: 1.4%-5.8%]) disease was diagnosed in the contralateral groin: five had contralateral non-SN metastasis at IFL and two developed an isolated contralateral groin recurrence after no further treatment. Five of them had a primary tumor ≥30 mm. Bilateral radiotherapy was administered in 122 patients, of whom one (1/122; 0.8% [95% CI: 0.1%–4.5%]) had a contralateral groin recurrence. The risk of contralateral lymph node metastases in patients with early-stage VSCC and a unilateral metastatic SN is low. It appears safe to limit groin treatment to unilateral IFL or inguinofemoral radiotherapy in these cases. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF