RESUMO
PURPOSE: The present consensus statement was developed by the GINECOR working group on behalf of the Spanish Society of Radiation Oncology (SEOR). Given the lack of prospective data on the management of vulvar carcinoma, this document provides an up-to-date review of radiotherapy treatment in vulvar cancer and a series of consensus-based recommendations from a group of experts. METHODS: A two-round, online modified Delphi study was conducted to reach consensus treatment recommendations in three clinical settings: 1) adjuvant treatment, 2) locally-advanced vulvar cancer (LAVC), and 3) recurrent disease. After the first round, we comprehensively reviewed the available medical literature from peer-reviewed journals to assess and define the evidence-based treatment options. In the second round, participants were asked to indicate their level of agreement with the preliminary recommendations according to the GRADE (Grade of Recommendation, Assessment, Development, and Evaluation) criteria, as follows: strongly agree; agree; neither agree nor disagree; disagree; strongly disagree. RESULTS: The main recommendations were as follows: 1) following surgical resection, adjuvant radiotherapy is recommended with the presence of adverse risk factors (primarily positive margins and lymph node involvement); 2) radiotherapy (with or without chemotherapy) should be considered in LAVC; and 3) in recurrent disease, radiotherapy should be individualised on a case-by-case basis. A high level of agreement over 80% was reached. CONCLUSIONS: In the absence of robust clinical data, these final recommendations may help to select the optimal radiotherapy approach for this relatively rare cancer.
Assuntos
Radioterapia (Especialidade) , Neoplasias Vulvares , Feminino , Humanos , Neoplasias Vulvares/radioterapia , Radioterapia Adjuvante , Linfonodos/patologia , ConsensoRESUMO
PURPOSE: The present consensus statement was developed by the GINECOR working group on behalf of the Spanish Society of Radiation Oncology (SEOR). This document provides an up-to-date review of the technical aspects in radiation treatment of vulvar cancer. METHODS: A two-round modified Delphi study was conducted to reach consensus on the appropriateness of technical aspects of external beam radiotherapy and brachytherapy. Three clinical scenarios were proposed: adjuvant treatment of vulvar cancer, radiation treatment of locally advanced vulvar carcinoma and locoregional recurrences. After the first round, an extensive analysis of current medical literature from peer-reviewed journal was performed to define evidence-based treatment options. In the second round, participants were asked to indicate their level of agreement with the preliminary recommendations according to the GRADE (Grade of Recommendation, Assessment, Development, and Evaluation) criteria, as follows: strongly agree; agree; neither agree nor disagree; disagree and strongly disagree. RESULTS: The main recommendations on external beam radiotherapy and brachytherapy, both in adjuvant setting and local advanced disease are summarized. Recommendations include treatment technique, treatment volume, and doses in target and organs at-risk. Taking into consideration the different clinical scenarios of recurrent disease, the radiation treatment should be individualized. CONCLUSIONS: In the absence of robust clinical data, these recommendations may help to select the optimal radiotherapy approach for this relatively rare cancer.
Assuntos
Braquiterapia , Carcinoma , Radioterapia (Especialidade) , Neoplasias Vulvares , Feminino , Humanos , Neoplasias Vulvares/radioterapia , Recidiva Local de Neoplasia/radioterapiaRESUMO
OBJECTIVE: The aim of our systematic review was to assess the role of interventional radiotherapy (IRT, brachytherapy) in the management of primary and/or recurrent vulvar carcinoma. EVIDENCE ACQUISITION: A systematic research using PubMed, Scopus and Cochrane library was performed. ClinicalTrials.gov was searched for ongoing or recently completed trials, and PROSPERO was searched for ongoing or recently completed systematic reviews. Only full-text English-language articles related to IRT for treatment of primary or recurrent VC were identified and reviewed. Conference paper, survey, letter, editorial, book chapter and review were excluded. Time restriction (1990-2018) as concerns the years of the publication was considered. EVIDENCE SYNTHESIS: Primary disease: the median 5-year LC was 43.5% (range 19-68%); the median 5-year DFS was 44.5% (range 44-81%); the median 5-year OS was 50.5% (range 27-85%). Recurrent disease: the median 5-year DFS was 64% (range 56-72%) and the median 5-year OS was 45% (range 33%-57%). Acute ≥ grade 2 toxicity was reported in three patients (1.6%). The severe late toxicity rates (grade 3-4) ranged from 0% to 14.3% (median 7.7%). CONCLUSION: IRT as part of primary treatment for primary and/or recurrent vulvar cancer is associated with promising clinical outcomes.
Assuntos
Braquiterapia/métodos , Recidiva Local de Neoplasia/radioterapia , Neoplasias Vulvares/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Braquiterapia/efeitos adversos , Intervalo Livre de Doença , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/cirurgia , Estudos Retrospectivos , Fatores de Tempo , Neoplasias Vulvares/mortalidade , Neoplasias Vulvares/cirurgiaRESUMO
Se presenta el caso clínico de una fémina de 32 años con seropositividad del virus de inmunodeficiencia humana desde hacía 2 años, quien acudió a la consulta de Ginecología del Hospital Gubernamental de Mbabane, en Suazilandia, por presentar una lesión en el labio mayor derecho de la vulva, unido a prurito y adenopatías en la región inguinal derecha. La paciente fue evaluada en la consulta de Oncología, donde se le diagnosticó un carcinoma basocelular invasivo de vulva, clasificado en estadio III luego de realizar los exámenes complementarios necesarios; posteriormente fue remitida a Sudáfrica para recibir radioterapia y quimioterapia combinadas.
The case report of a 32 years female patient is presented with seropositivity of the human immunodeficiency virus for 2 years who came to the Gynecology Service of Mbabane Government Hospital, in Swaziland, due to a lesion in the right major lip of the vulva, together with pruritus and adenopathies in the right inguinal region. The patient was examined in the Oncology Service, where a basal cellular invasive vulvar carcinoma was diagnosed. It was classified in stage III after carrying out the necessary laboratory exams; later on she was transferred to South Africa to receive combined radiotherapy and chemotherapy.
Assuntos
Essuatíni , Neoplasias Vulvares/radioterapia , Carcinoma Basocelular/radioterapia , HIV , Tratamento FarmacológicoRESUMO
Antecedentes: El carcinoma espinocelular (CEC) es una neoplasia epitelial maligna. La mayor parte se concentra en 4 áreas: cáncer de piel no melanoma, de cabeza y cuello, esofágico y pulmonar. El riesgo de metástasis de CEC es de 0,3-3,7 por ciento. El CEC vulvar representa aproximadamente un 3-5 por ciento de los cánceres ginecológicos. Caso clínico: Mujer de 86 años con prurito genital de larga data. Evaluada en varias oportunidades, siendo tratada como Herpes genital con valaciclovir, y Liquen Escleroso y Atrófico (LEA) con corticoides tópicos y tacrolimus con mala respuesta. Consultó por intenso prurito y nuevas lesiones vulvares. Al examen físico, destacaban 2 nódulos ulcerados en región periclitorídea izquierda e introito. La biopsia confirmó CEC bien diferenciado infiltrante. El TAC de abdomen y pelvis descartó metástasis. Se realizó radioterapia por 7 semanas. Por persistencia de la lesión, ingresó a cuidados paliativos. Dos años después la paciente está en buenas condiciones. Discusión: El CEC representa el 95 por ciento de las neoplasias vulvares. Existen 2 tipos: CEC en mujeres jóvenes, asociado a infección por virus papiloma humano de alto riesgo y CEC en mujeres mayores en relación a LEA. El 45-61 por ciento de los CEC de vulva se asocian a LEA preexistente, por lo que se recomienda el seguimiento de pacientes portadoras de LEA cada 6 meses. Conclusión: Es importante realizar biopsias de lesiones vulvares con mala respuesta a tratamiento, sobre todo si se asocia a LEA.
Background: Squamous cell carcinoma (SCC) is a malignant epithelial neoplasm. SCC can be divided into 4 groups: non-melanoma skin cancer (NMSC), head and neck, esophageal and lung cancer. The risk for metastasis of SCC is 0.3-3.7 percent. Vulvar SCC is approximately 3-5 percent of all gynecological cancers. Case report: An 86-year old woman with a history of several years of genital pruritus and many consultations for this reason, prior treatments included valacyclovir for genital herpes; topical corticosteroids and tachrolymus for lichen sclerosus et atrophicus (LEA) with poor response. She presented with pruritus and new vulvar lesions. Physical examination showed two ulcerated nodules on the left periclitorid region and the introitus. The biopsy confirmed an infiltrating well-differentiated SCC. CT-scans discarded metastases. She received 7 weeks of radiotherapy. Due to persistence of the tumor the patient entered palliative care. Two years afterwards the patient is in good condition. Discussion: SCC represents 95 percent of vulvar malignancies. There are 2 types: SCC in young women, associated with high-risk human papilloma virus infection and SCC in elder women associated to the preexistence of LEA. 45-61 percent of vulvar SCC is associated in with preexisting LEA. Patients with LEA should be followed every 6 months. Conclusion: It is important to perform biopsies of vulvar lesions that have poor response to treatment, especially if they are associated with LEA.
Assuntos
Humanos , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/radioterapia , Neoplasias Vulvares/diagnóstico , Neoplasias Vulvares/radioterapiaAssuntos
Aminoquinolinas/uso terapêutico , Antineoplásicos/uso terapêutico , Doença de Paget Extramamária/terapia , Doença de Paget Mamária/terapia , Neoplasias da Próstata/terapia , Neoplasias Vulvares/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Imiquimode , Masculino , Pessoa de Meia-Idade , Doença de Paget Extramamária/radioterapia , Doença de Paget Mamária/radioterapia , Neoplasias da Próstata/radioterapia , Neoplasias Vulvares/radioterapiaAssuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aminoquinolinas/uso terapêutico , Antineoplásicos/uso terapêutico , Doença de Paget Extramamária/terapia , Doença de Paget Mamária/terapia , Neoplasias da Próstata/terapia , Neoplasias Vulvares/terapia , Doença de Paget Extramamária/radioterapia , Doença de Paget Mamária/radioterapia , Neoplasias da Próstata/radioterapia , Neoplasias Vulvares/radioterapiaRESUMO
We report two cases of vulvar sarcomas that are our Institutional experience in 29 years. The first case was a teenager of 14 years-old with a low grade leiomyosarcoma surgically treated. Along a 22 years follow-up the disease has had four local recurrences of more than 5 cm each one: two after surgery and two after surgery plus chemotherapy and surgery plus radiotherapy respectively. She is alive disease evidence after two years from the last combined treatment. The second one, was a 26 years-old patient with a malignant schwannoma of 12 cm in diameter treated with combined radical surgery, radiotherapy, and chemotherapy. She is alive and without disease evidence 52 months after surgery. We emphasized that these tumors are very rare and the fact that the first patient is the youngest and with more years of follow up according the bibliography consulted. Treatment of vulvar sarcomas is radical local excision followed mainly by radiotherapy with infiltrating margins. The value of postoperative adjuvant chemotherapy is uncertain. According to the natural history and behavior of vulvar sarcomas, we conclude that the elective treatment of these tumors should be carry out in institutions of high level.
Assuntos
Leiomiossarcoma , Neurilemoma , Neoplasias Vulvares , Neoplasias Abdominais/tratamento farmacológico , Neoplasias Abdominais/radioterapia , Neoplasias Abdominais/secundário , Adolescente , Adulto , Antineoplásicos Alquilantes/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Glândulas Vestibulares Maiores , Quimioterapia Adjuvante , Terapia Combinada , Ciclofosfamida/administração & dosagem , Cistectomia , Cistos/diagnóstico , Dacarbazina/administração & dosagem , Dacarbazina/uso terapêutico , Diagnóstico Diferencial , Intervalo Livre de Doença , Doxorrubicina/administração & dosagem , Feminino , Seguimentos , Humanos , Leiomiossarcoma/diagnóstico , Leiomiossarcoma/tratamento farmacológico , Leiomiossarcoma/radioterapia , Leiomiossarcoma/secundário , Leiomiossarcoma/cirurgia , Recidiva Local de Neoplasia , Neurilemoma/tratamento farmacológico , Neurilemoma/radioterapia , Neurilemoma/cirurgia , Neoplasias Pélvicas/tratamento farmacológico , Neoplasias Pélvicas/radioterapia , Neoplasias Pélvicas/secundário , Teleterapia por Radioisótopo , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias da Bexiga Urinária/secundário , Neoplasias da Bexiga Urinária/cirurgia , Neoplasias Vulvares/diagnóstico , Neoplasias Vulvares/tratamento farmacológico , Neoplasias Vulvares/patologia , Neoplasias Vulvares/radioterapia , Neoplasias Vulvares/cirurgiaRESUMO
El carcinoma de vulva constituye del 3 al 5 por ciento de los tumores ginecológicos malignos. Su etiología exacta es desconocida. El 90 por ciento son epidermoides. Se presentan ocho casos de enfermas con carcinoma de vulva, de los cuales sólo el 12.5 por ciento correspondieron a lesiones tempranas. El tratamiento quirúrgico varió, dependiendo del estadio clínico: El manejo ganglionar estuvo sujeto a la localización de la lesión, la presencia o ausencia clínica de los ganglios y del estudio transoperatorio de los mismos. La radioterapia posoperatoria se utilizó en cinco enfermas (62.5 por ciento). Sólo un caso fue tratado con quimioterapia y radioterapia, pero los resultados no fueron valorables. La supervivencia con un seguimiento promedio de 24 meses fue de 62.5 por ciento. El factor pronóstico más importante fue el estado ganglionar. Es una neoplasia poco frecuente en nuestro medio, más de tres cuartas partes son lesiones avanzadas. Debe darse mayor interés a la detección temprana
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Metástase Linfática , Estadiamento de Neoplasias/efeitos adversos , Neoplasias Vulvares/tratamento farmacológico , Neoplasias Vulvares/radioterapia , Neoplasias Vulvares/cirurgia , Hospitais Gerais , MéxicoRESUMO
El tratamiento del carcinoma epidermoide de vulva es eminentemente quirúrgico, con excelentes resultados en estadios iniciales. Sin embargo, cuando la enfermedad se halla localmente avanzada, la eficacia de la cirugía decae significativamente, siendo la recurrencia local una situación sumamente frecuente a pesar del mayor esfuerzo quirúrgico. Objetivos: Evaluar en un estudio prospectivo la respuesta local a un esquema combinado y simultáneo de quimioterapia y radioterapia en el carcinoma epidermoide de vulva localmente avanzado o recidivado. Material y métodos: Ocho pacientes portadoras de carcinoma epidermoide de vulva localmente avanzado o recidivado fueron sometidas a un protocolo de quimioterapia y radioterapia simultáneas entre julio de 1993 y noviembre de 1994. El criterio de inclusión más importante fue la presencia de tumor vulvar (primario o recidivado) que invadiera estructuras vecinas o que, sin invadirlas, se hallase tan próximo a ellas que requiriera una cirugía exenterativa o no permitiera garantizar un margen de tejido libre satisfactorio sin recurrir a ella. Seis pacientes presentaban tumor primario y dos, recidivas posquirúrgicas. La media del tamaño tumoral fue de 7 cm. (rango 3-15 cm) y la media de superficie tumoral fue de 35 cm (rango 6-150 cm3). Se valoró la respuesta local y la toxicidad aguda al tratamiento. El esquema utilizado consistió en mitomicyn c 10 mg/m2/24 hs. día 1, y 5-fluoruracilo 800 mg/m2/24 hs. en infusión endovenosa continua días 1 a 4. Este esquema se repitió cada 21 días por dos ciclos. Se empleó telecobaltoterapia sobre tumor primario, regiones inguinales y pelvis con una dosis total de 45 -50 Gy., comenzando el día 1 de inicio del esquema...