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Neoadjuvant chemotherapy in vulvar cancer: avoiding primary exenteration
- Source :
- Gynecologic oncology. 100(1)
- Publication Year :
- 2004
-
Abstract
- Objective. To determine whether neoadjuvant cisplatin and 5-fluorouracil chemotherapy can be used to preserve the anal sphincter and/or urethra in patients with advanced vulvar cancer involving these sites. Methods. Fourteen patients with advanced vulvar cancer (1997–2003) involving the anal sphincter and/or urethra were given 3–4 cycles of neoadjuvant chemotherapy to attempt preservation of these pelvic structures rather than undergoing a primary pelvic exenteration. Following 3 cycles, a radical vulvectomy and groin lymph node dissection were planned. All patients had lesion size documented by measurement and photograph prior to and following chemotherapy. Results. The median age was 63 years (range 39–88). Thirteen patients received a median of 3 cycles (range 2–4) of neoadjuvant chemotherapy. Ten patients received cisplatin and 5-fluorouracil, while three received cisplatin alone. The median time from diagnosis to surgery was 77 days (range 54–143). All patients with cisplatin and 5-fluorouracil chemotherapy underwent surgery except one patient who had a synchronous renal cell carcinoma and died prior to surgery. Patients receiving cisplatin alone showed no measurable response, while all patients receiving cisplatin and 5-fluorouracil demonstrated at least a partial response. Two patients had no residual invasive carcinoma on final pathology. All patients receiving cisplatin and 5-fluorouracil followed by surgery are disease-free, while two of three receiving cisplatin have progressive disease. The anal sphincter and urethra were conserved in all patients receiving cisplatin and 5-fluorouracil. Conclusion. Neoadjuvant cisplatin and 5-fluorouracil in advanced vulvar cancer demonstrated a response rate of 100%. The anal sphincter and urethra were conserved in all patients receiving cisplatin and 5-fluorouracil. Responders are disease-free at this time. This response rate demonstrates superior activity of 5-fluorouracil in vulvar cancer and spares these patients the morbidity of exenteration or radiation.
- Subjects :
- Adult
medicine.medical_specialty
medicine.medical_treatment
Gynecologic Surgical Procedures
Renal cell carcinoma
Antineoplastic Combined Chemotherapy Protocols
medicine
Humans
Aged
Cisplatin
Aged, 80 and over
Chemotherapy
Pelvic exenteration
Vulvar Neoplasms
business.industry
Obstetrics and Gynecology
Vulvar cancer
Middle Aged
medicine.disease
Neoadjuvant Therapy
Surgery
Pelvic Exenteration
Dissection
Urethra
medicine.anatomical_structure
Oncology
Female
Fluorouracil
business
Progressive disease
medicine.drug
Subjects
Details
- ISSN :
- 00908258
- Volume :
- 100
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Gynecologic oncology
- Accession number :
- edsair.doi.dedup.....388355beb42d8a609d0745c2dfe7a0e6