Top

Published in:

01-05-2013 | Gynecologic Oncology

Secondary Sentinel Node Biopsy After Previous Excision of the Primary Tumor in Squamous Cell Carcinoma of the Vulva

Authors: Linn Woelber, MD, Donata Grimm, MD, Eik Vettorazzi, Christian Wisotzki, MD, Fabian Trillsch, MD, Fritz Jaenicke, MD, Joerg Schwarz, MD, Matthias Choschzick, Sven Mahner, MD

Published in: Annals of Surgical Oncology | Issue 5/2013

Abstract

Background

To reduce morbidity of radical groin dissection, the sentinel-node (SLN) procedure was implemented for the treatment of vulvar cancer. It has been proven to be a safe alternative in early-stage disease. Feasibility and safety of the procedure after previous vulvar surgery remain unclear.

Methods

A total of 106 patients with primary vulvar cancer undergoing the SLN procedure were analyzed. Seventy-four patients received the SLN procedure concomitant to vulvar surgery [primary-sentinel group (PSG)], whereas 32 patients had vulvar surgery before secondary SLN [secondary-sentinel group (SSG)].

Results

SLN detection was possible in all patients. Three (9.4 %) patients in the SSG and 30 (40.5 %) in the PSG had metastatic spread to the SLN and underwent radical groin dissection. Median interval between vulva surgery and secondary sentinel was 34 days (range, 7–98). In the SSG tumor, stages were earlier with smaller tumor size (median 19 mm in the PSG vs. 9 mm in the SSG) and lesser invasion depth (4 vs. 2 mm; p < 0.001). There were no groin recurrences in the SSG and 5.4 % in the PSG. No significant difference regarding disease-free survival (DFS) could be detected (3-year DFS of 72.5 % in the PSG compared with 92.5 % in the SSG (median DFS not reached, p = 0.114)). Adjusting for potential confounders (tumor stage, nodal status, tumor size, invasion depth) did not alter the results with regards to DFS.

Conclusions

Our results suggest that a secondary SLN procedure after previous vulvar surgery is feasible and can accurately reflect the groin status of selected patients. Ideally, prospective trials should be conducted to verify accuracy and oncologic safety of the procedure.

Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2007. CA Cancer J Clin. 2007;57:43–66.PubMedCrossRef

Jones RW, Baranyai J, Stables S. Trends in squamous cell carcinoma of the vulva: the influence of vulvar intraepithelial neoplasia. Obstet Gynecol. 1997;90:448–52.PubMedCrossRef

Woelber L, Choschzick M, Eulenburg C, et al. Prognostic value of pathological resection margin distance in squamous cell cancer of the vulva. Ann Surg Oncol. 2011.

Woelber L, Kock L, Gieseking F, et al. Clinical management of primary vulvar cancer. Eur J Cancer. 2011;47:2315–21.PubMedCrossRef

Woelber L, Eulenburg C, Choschzick M, et al. Prognostic role of lymph node metastases in vulvar cancer and implications for adjuvant treatment. Int J Gynecol Cancer. 2012;22:503–8.PubMedCrossRef

Rouzier R, Haddad B, Plantier F, et al. Local relapse in patients treated for squamous cell vulvar carcinoma: incidence and prognostic value. Obstet Gynecol. 2002;100:1159–67.PubMedCrossRef

Gaarenstroom KN, Kenter GG, Trimbos JB, et al. Postoperative complications after vulvectomy and inguinofemoral lymphadenectomy using separate groin incisions. Int J Gynecol Cancer. 2003;13:522–7.PubMedCrossRef

Van der Zee AG, Oonk MH, De Hullu JA, et al. Sentinel node dissection is safe in the treatment of early-stage vulvar cancer. J Clin Oncol. 2008;26:884–9.PubMedCrossRef

Oonk MH, de Hullu JA, van der Zee AG. Current controversies in the management of patients with early-stage vulvar cancer. Curr Opin Oncol. 22:481–6.

10.

de Hullu JA, Hollema H, Piers DA, et al. Sentinel lymph node procedure is highly accurate in squamous cell carcinoma of the vulva. J Clin Oncol. 2000;18:2811–6.PubMed

11.

Hauspy J, Beiner M, Harley I, et al. Sentinel lymph node in vulvar cancer. Cancer. 2007;110:1015–23.PubMedCrossRef

12.

Johann S, Klaeser B, Krause T, Mueller MD. Comparison of outcome and recurrence-free survival after sentinel lymph node biopsy and lymphadenectomy in vulvar cancer. Gynecol Oncol. 2008;110: 324–8.PubMedCrossRef

13.

Levenback C, Coleman RL, Burke TW, et al. Intraoperative lymphatic mapping and sentinel node identification with blue dye in patients with vulvar cancer. Gynecol Oncol. 2001;83:276–81.PubMedCrossRef

14.

Moore RG, DePasquale SE, Steinhoff MM, et al. Sentinel node identification and the ability to detect metastatic tumor to inguinal lymph nodes in squamous cell cancer of the vulva. Gynecol Oncol. 2003;89:475–9.PubMedCrossRef

15.

Terada KY, Shimizu DM, Jiang CS, Wong JH. Outcomes for patients with T1 squamous cell cancer of the vulva undergoing sentinel node biopsy. Gynecol Oncol. 2006;102:200–3.PubMedCrossRef

16.

McCready DR, Ghazarian DM, Hershkop MS, et al. Sentinel lymph-node biopsy after previous wide local excision for melanoma. Can J Surg. 2001;44:432–4.PubMed

17.

Gannon CJ, Rousseau DL Jr, Ross MI, et al. Accuracy of lymphatic mapping and sentinel lymph node biopsy after previous wide local excision in patients with primary melanoma. Cancer. 2006;107:2647–52.PubMedCrossRef

18.

Beller U, Quinn MA, Benedet JL, et al. Carcinoma of the vulva. FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer. Int J Gynaecol Obstet. 2006;95(Suppl 1):S7–27.PubMedCrossRef

19.

Benedet JL, Bender H, Jones H 3^rd, et al. FIGO staging classifications and clinical practice guidelines in the management of gynecologic cancers. FIGO Committee on Gynecologic Oncology. Int J Gynaecol Obstet. 2000;70:209–62.PubMedCrossRef

20.

R-Development-Core-Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing. Vienna, Austria. ISBN 3-900051-07-0. http://www.R-project.org. 2010.

21.

Homesley HD, Bundy BN, Sedlis A, et al. Assessment of current International Federation of Gynecology and Obstetrics staging of vulvar carcinoma relative to prognostic factors for survival (a Gynecologic Oncology Group study). Am J Obstet Gynecol. 1991;164:997–1003; discussion 1003–4.

22.

Crosbie EJ, Winter-Roach B, Sengupta P, et al. The accuracy of the sentinel node procedure after excision biopsy in squamous cell carcinoma of the vulva. Surg Oncol. 19:e150–4.

23.

Woelber L, Mahner S, Voelker K, et al. Clinicopathological prognostic factors and patterns of recurrence in vulvar cancer. Anticancer Res. 2009;29:545–52.PubMed

24.

Bell JG, Lea JS, Reid GC. Complete groin lymphadenectomy with preservation of the fascia lata in the treatment of vulvar carcinoma. Gynecol Oncol. 2000;77:314–8.PubMedCrossRef

25.

Ariyan S, Ali-Salaam P, Cheng DW, Truini C. Reliability of lymphatic mapping after wide local excision of cutaneous melanoma. Ann Surg Oncol. 2007;14:2377–83.PubMedCrossRef

26.

Uren RF, Howman-Giles RB, Shaw HM, et al. Lymphoscintigraphy in high-risk melanoma of the trunk: predicting draining node groups, defining lymphatic channels and locating the sentinel node. J Nucl Med. 1993;34:1435–40.PubMed

27.

Sumner WE 3rd, Ross MI, Mansfield PF, et al. Implications of lymphatic drainage to unusual sentinel lymph node sites in patients with primary cutaneous melanoma. Cancer. 2002;95:354–60.PubMedCrossRef

28.

Porter GA, Ross MI, Berman RS, et al. Significance of multiple nodal basin drainage in truncal melanoma patients undergoing sentinel lymph node biopsy. Ann Surg Oncol. 2000;7:256–61.PubMedCrossRef

29.

Evans HL, Krag DN, Teates CD, et al. Lymphoscintigraphy and sentinel node biopsy accurately stage melanoma in patients presenting after wide local excision. Ann Surg Oncol. 2003;10:416–25.PubMedCrossRef

30.

Karakousis CP, Grigoropoulos P. Sentinel node biopsy before and after wide excision of the primary melanoma. Ann Surg Oncol. 1999;6:785–9.PubMedCrossRef

31.

Rodolakis A, Diakomanolis E, Voulgaris Z, et al. Squamous vulvar cancer: a clinically based individualization of treatment. Gynecol Oncol. 2000;78:346–51.PubMedCrossRef

32.

Hacker NF, Berek JS, Lagasse LD, et al. Management of regional lymph nodes and their prognostic influence in vulvar cancer. Obstet Gynecol. 1983;61:408–12.PubMed

Title: Secondary Sentinel Node Biopsy After Previous Excision of the Primary Tumor in Squamous Cell Carcinoma of the Vulva
Authors: Linn Woelber, MD
Donata Grimm, MD
Eik Vettorazzi
Christian Wisotzki, MD
Fabian Trillsch, MD
Fritz Jaenicke, MD
Joerg Schwarz, MD
Matthias Choschzick
Sven Mahner, MD
Publication date: 01-05-2013
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 5/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-012-2735-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Secondary Sentinel Node Biopsy After Previous Excision of the Primary Tumor in Squamous Cell Carcinoma of the Vulva

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 5/2013

Clinical Significance of 18F-fluorodeoxyglucose Positron Emission Tomography in Superficial Esophageal Squamous Cell Carcinoma

Predictors for Major Wound Complications Following Preoperative Radiotherapy and Surgery for Soft-Tissue Sarcoma of the Extremities and Trunk: Importance of Tumor Proximity to Skin Surface

Seventh Edition (2010) of the AJCC/UICC Staging System for Gastric Adenocarcinoma: Is there Room for Improvement?

Role of Preoperative Colonoscopy in Patients with Gastric Cancer: A Case Control Study of the Prevalence of Coexisting Colorectal Neoplasms

Conditional Probability of Survival Nomogram for 1-, 2-, and 3-Year Survivors After an R0 Resection for Gastric Cancer

Effectiveness of OK-432 (Sapylin) to Reduce Seroma Formation After Axillary Lymphadenectomy for Breast Cancer