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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]

In this brief report, we present our experience with 3-weekly paclitaxel-carboplatin chemotherapy for patients with vulvar cancer. Two patients with locally advanced disease had an impressive response allowing standard vulvar cancer surgery. One patient with metastatic disease had local stable disease though it was progressive in the lymph nodes. The available literature is sparse and retrospective. Based on promising results, however, a prospective multicenter study is mandatory in order to obtain full data in a larger series of patients in order to learn the benefits of neoadjuvant paclitaxel-carboplatin and compare the results with chemoradiation. [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]

The phrase "locally advanced carcinoma of the vulva" has often been mentioned in the literature, though not accurately defined, or even leading to the interpretation overlapping. Grounded on cervical cancer experience, we are able to state that designing a tailored primary strategy based on clinically measurable adverse prognostic factors represents the cornerstone of therapy. This fact urged us to rethink about the real usefulness of the concept of locally advanced squamous cell carcinoma of the vulva. We will refer to this concept as a clinical entity emerging from a rigorous workup which is a valuable guiding tool in the context of a thorough debate about the best primary treatment approach to be used. Furthermore, bulky tumors of the vulva have been associated with a worse prognosis on several occasions. Some authors have questioned the fact that tumor size has not been considered in the staging system. Finally, a standardized definition will help us compare the results obtained, which is extremely necessary given the worldwide low prevalence of this disease. [ABSTRACT FROM AUTHOR]

Objective: The therapeutic outcomes of patients with advanced vulvar cancer are poor. Multi-modality treatments including concurrent chemoradiation or different regimens of neoadjuvant chemotherapy (NACT), and surgery have been explored to reduce the extent of surgery and morbidity. The present single-institution trial aimed to evaluate the efficacy and toxicity of paclitaxel and cisplatin in locally advanced vulvar cancer. Methods: From 2002 to 2009, 10 patients with stage III-IV locally advanced squamous cell carcinoma of the vulva were prospectively treated with 3 courses of paclitaxel-ifosfamide-cisplatin or paclitaxel-cisplatin. Nine of them subsequently underwent radical local excision or radical partial vulvectomy and bilateral inguino-femoral lymphadenectomy. Results: The clinical response rate of all enrolled patients was 80%, whereas the pathological responses included 1 case with complete remission, 2 with persistent carcinoma in situ, and 6 invasive cancer cases with tumor shrinkage of more than 50%. Four patients had positive nodes. Forty percent of patients experienced grade 3-4 bone marrow toxicity, which was successfully managed with granulocyte-colony stimulating factor, even in cases of elderly patients. Median progression-free survival after surgery was 14 months (range, 5 to 44 months). Six of the 7 recurrent cases were local, and 3 of them were treated with salvage surgery while the other 3 received radiation with or without chemotherapy. After a median follow-up period of 40 months (range, 5 to 112 months), 55.5% of patients remained alive with no evidence of disease, including 2 long-term survivors after recurrence at 5 and 9 years. Conclusion: Based on the high response rate and manageable toxicity, NACT with paclitaxel and cisplatin with or without ifosfamide followed by surgery could be considered as a therapeutic option for locally advanced vulvar cancer. [ABSTRACT FROM AUTHOR]