Advertisement

When is it safe to omit contralateral groin management in unilateral sentinel node-positive early stage vulvar cancer?

  • Yilin Cao
    Affiliations
    Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
    Search for articles by this author
  • Akila Viswanathan
    Correspondence
    Corresponding author at: Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Medicine, Weinberg Building Suite 1440, Baltimore, MD 21231, USA.
    Affiliations
    Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
    Search for articles by this author
      The Groningen International Study on Sentinel Nodes in Vulvar Cancer (GROINSS-V) has become synonymous with treatment morbidity reduction in early stage vulvar cancer. Between the first and second iteration of the studies conducted from 2000 to 2016, nearly 2000 patients with primary tumor size <4 cm, primary tumor depth of invasion (DOI) ≥1 mm, and node-negative clinical staging were evaluated with sentinel lymph node (SLN) biopsy in an effort to define patient subgroups that could be safely spared the morbid inguinofemoral lymphadenectomy (IFL) procedure [
      • Wagner M.M.
      • van der Zee A.G.J.
      • Oonk M.H.M.
      History and updates of the GROINSS-V studies.
      ]. To date, the GROINSS-V I and II analyses have focused on the utility of SLN biopsy in reducing ipsilateral groin treatment burden. However, clinical trial data on how SLN biopsy can inform contralateral groin management is sparse. In the article that accompanies this editorial [
      • van der Kolk W.
      • et al.
      Unilateral inguinofemoral lymphadenectomy in patients with early-stage vulvar squamous cell carcinoma and a unilateral metastatic sentinel lymph node is safe.
      ], the authors report the risk of synchronous contralateral groin non-SLN involvement and the risk of contralateral groin recurrence in a subset of 366 patients from GROINSS-V I and II who had a unilateral positive SLN, and conclude that omission of contralateral IFL is safe in well-selected early-stage vulvar cancer patients.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Gynecologic Oncology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Wagner M.M.
        • van der Zee A.G.J.
        • Oonk M.H.M.
        History and updates of the GROINSS-V studies.
        Cancers (Basel). Apr. 2022; 14https://doi.org/10.3390/cancers14081956
        • van der Kolk W.
        • et al.
        Unilateral inguinofemoral lymphadenectomy in patients with early-stage vulvar squamous cell carcinoma and a unilateral metastatic sentinel lymph node is safe.
        Gynecol. Oncol. 2022; 167: 3-10
        • Zach D.
        • Åvall-Lundqvist E.
        • Falconer H.
        • Hellman K.
        • Johansson H.
        • Flöter Rådestad A.
        Patterns of recurrence and survival in vulvar cancer: A nationwide population-based study.
        Gynecol. Oncol. 2021; 161: 748-754https://doi.org/10.1016/j.ygyno.2021.03.013
        • Carlson J.W.
        • et al.
        GOG 244-The lymphedema and gynecologic cancer (LEG) study: Incidence and risk factors in newly diagnosed patients.
        Gynecol. Oncol. 2020; 156: 467-474https://doi.org/10.1016/j.ygyno.2019.10.009
        • de Hullu J.A.
        • et al.
        Sentinel lymph node procedure is highly accurate in squamous cell carcinoma of the vulva.
        J. Clin. Oncol. Aug. 2000; 18: 2811-2816https://doi.org/10.1200/JCO.2000.18.15.2811
        • Meads C.
        • et al.
        Sentinel lymph node biopsy in vulval cancer: systematic review and meta-analysis.
        Br. J. Cancer. Jun. 2014; 110: 2837-2846https://doi.org/10.1038/bjc.2014.205
        • van der Zee A.G.J.
        • et al.
        Sentinel node dissection is safe in the treatment of early-stage vulvar cancer.
        J. Clin. Oncol. Feb. 2008; 26: 884-889https://doi.org/10.1200/JCO.2007.14.0566
        • Oonk M.H.M.
        • et al.
        Radiotherapy versus inguinofemoral lymphadenectomy as treatment for vulvar cancer patients with micrometastases in the sentinel node: results of GROINSS-V II.
        J. Clin. Oncol. 2021; 39: 3623-3632https://doi.org/10.1200/JCO.21.00006
        • Gonzalez Bosquet J.
        • et al.
        Patterns of inguinal groin metastases in squamous cell carcinoma of the vulva.
        Gynecol. Oncol. Jun. 2007; 105: 742-746https://doi.org/10.1016/j.ygyno.2007.02.014