Abstract：
To assess clinical outcomes of inguinal lymph node surgical resection compared to primary groin radiotherapy for locally advanced, surgically unresectable vulvar cancer.
All patients treated with radiation for vulvar cancer were identified between Jan 1, 2000 - Dec 31, 2020 at 2 academic centres. Inclusion criteria were those treated with curative intent primary radiotherapy +/- chemotherapy, tumors >4 cm, and surgically unresectable squamous cell vulvar carcinoma. Groin recurrence-free survival (RFS) was compared for groin surgery and primary groin radiotherapy using the Kaplan Meier method and log rank test. Groin failures are described by treatment modality, radiation dose and lymph node size.
Of 476 patients treated with radiation for vulvar cancer, 112 patients (23.5%) met inclusion and exclusion criteria. The median (95% CI) follow up was 1.9 (1.4-2.5) years. Complete clinical response was significantly higher (80.0%) in patients with surgical groin resection compared to patients treated with primary groin radiotherapy (58.2%) (p = 0.04). On multivariable analysis, after adjusting for clinical and/or radiologically abnormal lymph nodes (p = 0.67), surgical groin resection was significantly associated with lower groin recurrence (HR 0.2 (95%CI 0.05-0.92), p = 0.04). The 3-year groin recurrence-free survival (RFS) was significantly higher at 94.4% (87.1-100) in patients with surgical groin resection compared to 79.2% (69.1-90.9) in patients treated with primary radiation (p = 0.02).
In locally advanced squamous cell vulvar cancer, surgical groin management improves groin RFS compared to radiotherapy alone.
All patients treated with radiation for vulvar cancer were identified between Jan 1, 2000 - Dec 31, 2020 at 2 academic centres. Inclusion criteria were those treated with curative intent primary radiotherapy +/- chemotherapy, tumors >4 cm, and surgically unresectable squamous cell vulvar carcinoma. Groin recurrence-free survival (RFS) was compared for groin surgery and primary groin radiotherapy using the Kaplan Meier method and log rank test. Groin failures are described by treatment modality, radiation dose and lymph node size.
Of 476 patients treated with radiation for vulvar cancer, 112 patients (23.5%) met inclusion and exclusion criteria. The median (95% CI) follow up was 1.9 (1.4-2.5) years. Complete clinical response was significantly higher (80.0%) in patients with surgical groin resection compared to patients treated with primary groin radiotherapy (58.2%) (p = 0.04). On multivariable analysis, after adjusting for clinical and/or radiologically abnormal lymph nodes (p = 0.67), surgical groin resection was significantly associated with lower groin recurrence (HR 0.2 (95%CI 0.05-0.92), p = 0.04). The 3-year groin recurrence-free survival (RFS) was significantly higher at 94.4% (87.1-100) in patients with surgical groin resection compared to 79.2% (69.1-90.9) in patients treated with primary radiation (p = 0.02).
In locally advanced squamous cell vulvar cancer, surgical groin management improves groin RFS compared to radiotherapy alone.
摘要：
目的：评估腹股沟淋巴结手术切除与单纯腹股沟放疗治疗局部晚期的临床疗效，手术无法切除的外阴癌.
方法：在2000年1月1日至2020年12月31日期间，在2个学术中心确定了所有接受外阴癌放射治疗的患者。纳入标准是接受根治性放疗+/-化疗的患者，肿瘤>4厘米，手术无法切除的鳞状细胞外阴癌。使用KaplanMeier方法和logrank检验比较腹股沟手术和原发性腹股沟放疗的腹股沟无复发生存率（RFS）。腹股沟故障由治疗方式描述，辐射剂量和淋巴结大小。
结果：在476例因外阴癌接受放射治疗的患者中，112例患者（23.5%）符合纳入和排除标准。中位随访时间（95%CI）为1.9（1.4-2.5）年。与接受原发性腹股沟放疗的患者（58.2％）相比，接受手术腹股沟切除术的患者的完全临床反应明显更高（80.0％）（p=0.04）。在多变量分析中，在调整临床和/或放射学异常淋巴结后（p=0.67），腹股沟手术切除与腹股沟复发率降低显著相关(HR0.2(95CI0.05-0.92),p=0.04)。手术腹股沟切除术患者的3年无腹股沟复发生存率（RFS）显着高于94.4％（87.1-100），而接受原发性放射治疗的患者为79.2％（69.1-90.9）（p=0.02）。
结论：在局部晚期鳞状细胞外阴癌中，与单纯放疗相比,腹股沟外科治疗可改善腹股沟RFS.
方法：在2000年1月1日至2020年12月31日期间，在2个学术中心确定了所有接受外阴癌放射治疗的患者。纳入标准是接受根治性放疗+/-化疗的患者，肿瘤>4厘米，手术无法切除的鳞状细胞外阴癌。使用KaplanMeier方法和logrank检验比较腹股沟手术和原发性腹股沟放疗的腹股沟无复发生存率（RFS）。腹股沟故障由治疗方式描述，辐射剂量和淋巴结大小。
结果：在476例因外阴癌接受放射治疗的患者中，112例患者（23.5%）符合纳入和排除标准。中位随访时间（95%CI）为1.9（1.4-2.5）年。与接受原发性腹股沟放疗的患者（58.2％）相比，接受手术腹股沟切除术的患者的完全临床反应明显更高（80.0％）（p=0.04）。在多变量分析中，在调整临床和/或放射学异常淋巴结后（p=0.67），腹股沟手术切除与腹股沟复发率降低显著相关(HR0.2(95CI0.05-0.92),p=0.04)。手术腹股沟切除术患者的3年无腹股沟复发生存率（RFS）显着高于94.4％（87.1-100），而接受原发性放射治疗的患者为79.2％（69.1-90.9）（p=0.02）。
结论：在局部晚期鳞状细胞外阴癌中，与单纯放疗相比,腹股沟外科治疗可改善腹股沟RFS.
