Clinical Course of Node-Positive Squamous Cell Carcinoma of the Vulva without Adjuvant Radiotherapy

Aim: Radiotherapy, the most important adjuvant treatment modality for node-positive vulvar cancer, can cause severe lymphedema after inguinofemoral lymphadenectomy. To investigate the prognosis and toxicity outcomes of patients with node-positive vulvar cancer treated with surgery but not adjuvant radiotherapy. Methods: We performed a retrospective analysis of six patients who were treated at our center from 1992 to 2015. All of these patients underwent radical surgery accompanying inguinofemoral lymphadenectomy, and were histologically diagnosed with node-positive squamous cell carcinoma of the vulva. Results: The median length of survivor follow-up was 52 months, and the median number of lymph node metastases was 1.5 (range=1-4). Four patients received adjuvant platinum-based combined chemotherapy, and the other two patients refused chemotherapy. Recurrence was seen in three cases, and one patient who showed local recurrence had not received adjuvant chemotherapy. The median length of time to recurrence was 14 months. For the three patients with local recurrence, two patients showed local recurrence and one showed lung metastasis; radiotherapy was administered for these patients. The 3-year progression-free survival rate was 41.7%, and the 3-year overall survival rate was 80%. Grade 3 neutropenia was seen in one patient. Conclusion: We showed a favorable prognosis of node-positive squamous cell carcinoma of the vulva without adjuvant radiotherapy. Adjuvant chemotherapy without radiotherapy may avoid excessive local therapy, and is expected to decrease distant metastasis risk, resulting in favorable prognosis. Further clinical trials are needed to prove its utility.