Midline involvement as a risk factor for vulvar cancer recurrence.

OBJECTIVE This observational study was to identify risk factors for vulvar cancer recurrence. MATERIALS AND METHODS In the study 107 patients with primary vulvar cancer were analyzed. Surgical treatment consisted of radical excision of the primary tumor in combination with unilateral or bilateral superficial and deep inguinofemoral lymphadenectomy through separate incisions. Patients with deeper tumor invasion >1 mm or wider than 2 cm and/or groin lymphnode metastases were referred for adjuvant radiotherapy. Those with large primary vulvar tumors received neoadjuvant radiotherapy of 30 Gy followed by surgical treatment and adjuvant radiotherapy. RESULTS Most of patients had only primary radiotherapy to the vulva and inguinal lymph nodes and only 34.5% of patients were eligible for surgical treatment. In 5 year follow-up period 25.2% (27) patients were alive without the disease, 15.0% (16) were alive with the disease and 59.8% (64) were dead. 60.7% (65) patients experienced local recurrence and 2.8% (3) patients had distant metastases. Median survival for patients without recurrent disease was 38.9 ± 3.2 months and 36.0 ± 2.6 months with no statistically significant difference. Patients with early stage vulvar cancer had longer mean survival rates-for stage I 53.1 ± 3.4 months, 38.4 ± 4.4 months for stage II and 33.4 ± 2.6 and 15.6 ± 5.2 months for patients with stage III and stage IV vulvar cancer, respectively. The only significant prognostic factor predicting vulvar cancer recurrence was involvement of the midline. CONCLUSIONS Patients having midline involvement of vulvar cancer has lower recurrence risk, probably because of receiving more aggressive treatment. There is a tendency for lower vulvar cancer recurrence risk for patients over 70 years of age and patients who are receiving radiotherapy as an only treatment without surgery, but tendency for higher risk of recurrence in patients with multifocal vulvar cancer.