10th November 2017, Volume 130 Number 1465

Prashanth Hari Dass, Marion Kuper-Hommel

Vulvar cancers account for 0.6% of female cancers in the US.1 In New Zealand, the Ministry of Health registered 70 vulvar cancer cases in 2014 with rates reported to be…

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Summary

We report one of the largest retrospective single-centre review of vulvar cancers in Australasia. Multiple factors including patient choice, tumour location, advanced age, patients’ comorbidities and treatment complications have influenced and individualised treatment. Variation in treatment over the course of time, especially in the latter years were observed. Independent of Stage of vulvar cancer, patients with less comorbidities had a better overall survival. Although, treatment was associated with high morbidity, cisplatin chemo-radiotherapy was better tolerated, however this requires validation in larger prospective studies.

Abstract

Aim

Squamous cell vulvar cancers (SCVC) are rare. Although management guidelines have recently been published, New Zealand studies presenting “real world” outcomes are limited.

Method

Retrospective single-centre review of SCVC diagnosed between 1 January 2000 and 31 August 2015. Clinical characteristics and outcomes were reviewed.

Results

Among 47 cases reviewed, 38 were ethnically European and 9 Māori. Cases identified as Stage 1 (16), Stage 2 (5), Stage 3 (17), Stage 4 (9). For Stages 1, 2, 3 and 4, (16, 4, 17 and 6) were managed by local excision; (9, 1, 14 and 2) by node dissection and (2, 1, 3 and 5) by chemoradiotherapy respectively. Wound cellulitis (10) and lymphedema (8) were the commonest acute and late complication, respectively. Seven patients were treated with 5-Fluorouracil and Mitomycin, and four received weekly Cisplatin. Grade 3 toxicities seen in five cases treated with 5-Fluorouracil and Mitomycin versus none in the Cisplatin group. No local recurrences observed in patients treated with chemoradiation. Patients with Age Adjusted Charlson Comorbid Index Score (ACCIS) <5 had better overall survival (OS) compared to scores ≥5 (60% versus 41%) with 33 months median follow-up. Five-year OS and disease-free specific survival was 73% and 94% (Stage 1), 40% and 60% (Stage 2), 44% and 59% (Stage 3) and 29% (Stage 4) respectively.

Conclusion

We present “real world” outcomes of vulvar cancers in this older and comorbid population. Larger, prospective multi-centre studies are proposed.

Author Information

Prashanth Hari Dass, Medical Oncology Clinical Trial and Research Fellow, University of Oxford, United Kingdom; Marion JJ Kuper-Hommel, Medical Oncologist, Lomas Building, Waikato Hospital, Pembroke Street, Hamilton.

Acknowledgements

We sincerely thank Dr Ian Kennedy, the staff of Waikato Hospital Oncology Department and Sai Lakshmi Panatt for their valued input during the study.

Correspondence

Dr Prashanth Hari Dass, Medical Oncology Clinical Trial and Research Fellow, University of Oxford, United Kingdom.

Correspondence Email

pranava108@hotmail.com

Competing Interests

Nil.

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