Role of paclitaxel and cisplatin as the neoadjuvant treatment for locally advanced squamous cell carcinoma of the vulva.
- Author:
Francesco RASPAGLIESI
1
;
Flavia ZANABONI
;
Fabio MARTINELLI
;
Santiago SCASSO
;
Joel LAUFER
;
Antonino DITTO
Author Information
- Publication Type:Original Article
- Keywords: Locally advanced vulvar cancer; Morbidity; Neoadjuvant chemotherapy; Paclitaxel and cisplatin; Surgical treatment
- MeSH: Aged; Bone Marrow; Carcinoma in Situ; Carcinoma, Squamous Cell*; Cisplatin*; Disease-Free Survival; Drug Therapy; Follow-Up Studies; Humans; Ifosfamide; Lymph Node Excision; Neoadjuvant Therapy*; Paclitaxel*; Prospective Studies; Recurrence; Survivors; Vulva*; Vulvar Neoplasms
- From:Journal of Gynecologic Oncology 2014;25(1):22-29
- CountryRepublic of Korea
- Language:English
- Abstract: OBJECTIVE: The therapeutic outcomes of patients with advanced vulvar cancer are poor. Multi-modality treatments including concurrent chemoradiation or different regimens of neoadjuvant chemotherapy (NACT), and surgery have been explored to reduce the extent of surgery and morbidity. The present single-institution trial aimed to evaluate the efficacy and toxicity of paclitaxel and cisplatin in locally advanced vulvar cancer. METHODS: From 2002 to 2009, 10 patients with stage III-IV locally advanced squamous cell carcinoma of the vulva were prospectively treated with 3 courses of paclitaxel-ifosfamide-cisplatin or paclitaxel-cisplatin. Nine of them subsequently underwent radical local excision or radical partial vulvectomy and bilateral inguino-femoral lymphadenectomy. RESULTS: The clinical response rate of all enrolled patients was 80%, whereas the pathological responses included 1 case with complete remission, 2 with persistent carcinoma in situ, and 6 invasive cancer cases with tumor shrinkage of more than 50%. Four patients had positive nodes. Forty percent of patients experienced grade 3-4 bone marrow toxicity, which was successfully managed with granulocyte-colony stimulating factor, even in cases of elderly patients. Median progression-free survival after surgery was 14 months (range, 5 to 44 months). Six of the 7 recurrent cases were local, and 3 of them were treated with salvage surgery while the other 3 received radiation with or without chemotherapy. After a median follow-up period of 40 months (range, 5 to 112 months), 55.5% of patients remained alive with no evidence of disease, including 2 long-term survivors after recurrence at 5 and 9 years. CONCLUSION: Based on the high response rate and manageable toxicity, NACT with paclitaxel and cisplatin with or without ifosfamide followed by surgery could be considered as a therapeutic option for locally advanced vulvar cancer.
