目的:致敏铂外照射是局部晚期外阴癌的推荐治疗方法,不适合根治性手术,并伴有严重的急性和慢性副作用。用于持续性疾病的放射后根治性外阴切除术通常因伤口愈合不良而受损。我们描述了局部晚期外阴癌患者接受新辅助化疗加贝伐单抗后接受根治性外阴切除术的临床结果。
方法:我们对2015年1月至2023年11月在我院接受根治性外阴切除术的所有患者进行了回顾性分析。113名患者中,13例患者接受新辅助化疗。人口统计学和临床病理数据被提取,并进行描述性统计分析。进一步评估新辅助化疗加贝伐单抗的疗效,不利影响,和生存。
结果:对13例II-IV期累及尿道的患者进行新辅助化疗,阴道,或肛门。病变大小为4至20厘米(中位数7厘米)。患者接受2-6个周期的卡铂或顺铂,紫杉醇,和贝伐单抗.9例(69.2%)患者有部分病理反应,4名患者有完全缓解。所有患者的手术切缘均为阴性。10例(76.9%)患者在新辅助化疗之前有腹股沟淋巴结转移的影像学证据,四个有残留淋巴结病。只有一名患者出现浅表性腹股沟血清肿。三名患者复发,两个在本地,一个在远处,有一次死亡.中位随访时间为23个月(6-84个月)。
结论:铂/紫杉醇/贝伐单抗联合新辅助化疗对局部晚期外阴癌有效,导致完全切除,负边距,良好的伤口愈合。有必要进行多机构II期试验来验证这些发现。
OBJECTIVE: External beam radiation with sensitizing platinum is the recommended therapy for locally advanced vulvar cancers not amenable to curative surgery and is associated with considerable acute and chronic side effects. Radical
vulvectomy post-radiation for persistent disease is often compromised with poor wound healing. We describe clinical outcomes for patients who received neoadjuvant chemotherapy plus bevacizumab followed by radical
vulvectomy for locally advanced vulvar cancer.
METHODS: We performed retrospective analyses of all patients at our institution who underwent radical
vulvectomy from January 2015 to November 2023. Of 113 patients, 13 patients underwent neoadjuvant chemotherapy. Demographics and clinicopathologic data were extracted, and descriptive statistical analyses were performed. Cases with neoadjuvant chemotherapy plus bevacizumab were further evaluated for response, adverse effects, and survival.
RESULTS: Neoadjuvant chemotherapy was administered to 13 patients with stage II-IV disease that involved the urethra, vagina, or anus. Lesion sizes ranged from 4 to 20 cm (median 7 cm). Patients received 2-6 cycles of carboplatin or cisplatin, paclitaxel, and bevacizumab. Nine (69.2%) patients had partial pathologic responses, and four patients had complete responses. All patients had negative surgical margins. Ten (76.9%) patients had radiographic evidence of inguinal lymph node metastasis prior to neoadjuvant chemotherapy, and four had residual nodal disease. Only one patient developed a superficial groin seroma. Three patients developed recurrence, two locally and one distant, and there was one death. The median follow-up was 23 months (range 6-84 months).
CONCLUSIONS: Neoadjuvant chemotherapy using combination platinum/paclitaxel/bevacizumab was efficacious for locally advanced vulvar cancer, resulting in complete resections, negative margins, and excellent wound healing. A multi-institutional phase II trial is warranted to validate these findings.