AUTHOR=Ferrari Federico , Ismail Lamiese , Sabbagh Ahmad , Hardern Kieran , Owens Robert , Gozzini Elisa , Soleymani Majd Hooman 

TITLE=Adjuvant Radiotherapy for Groin Node Metastases Following Surgery for Vulvar Cancer: A Systematic Review

JOURNAL=Oncology Reviews

VOLUME=Volume 18 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/oncology-reviews/articles/10.3389/or.2024.1389035

DOI=10.3389/or.2024.1389035

ISSN=1970-5557

ABSTRACT=Background: Lymph node metastasis in vulvar cancer is a critical prognostic factor, associated with higher recurrence and decreased survival. A survival benefit is reported with adjuvant radiotherapy, but with potential significant morbidity. We aim to clarify whether there is high-quality evidence to support the use of adjuvant radiotherapy in this setting.Objectives: To assess the effectiveness and safety of adjuvant radiotherapy to loco-regional metastatic nodal areas.Search methods: We conducted a comprehensive and systematic literature search of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Google Scholar, ClinicalTrials.gov and the National Cancer Institute. We considered only randomized controlled trials (RCT).Main results: We identified 1760 records and finally retrieved only one eligible RCT (114 participants with positive inguinofemoral lymph nodes). All women underwent radical vulvectomy and bilateral inguinal lymphadenectomy and randomized to adjuvant radiotherapy or to intraoperative ipsilateral pelvic lymphadenectomy without adjuvant radiotherapy. At 6-years, overall survival (OS) was 51% versus 41% in favor of radiotherapy (HR 0.61; 95%CI 0.30-1.3) without significance and with a very low-certainty evidence. At 6-years, the cumulative incidence of cancer-related deaths was 29% versus 51% in favor to adjuvant radiotherapy (HR 0.49; 95%CI 0.28-0.87). Recurrence free survival at 6years was 59% after adjuvant radiotherapy versus 48% after pelvic lymphadenectomy (HR 0.39; 95%CI 0.17-0.88). Three (5.3%) versus 13 (24.1%) groin recurrences were noted respectively in the adjuvant radiotherapy and pelvic lymphadenectomy group. There was no significant difference for acute toxicities for pelvic lymphadenectomy compared to radiotherapy. In women with positive pelvic lymph nodes (20%), the OS at 6-years was 36% compared with 13%, in favor to adjuvant radiotherapy.Late cutaneous toxicity rate appeared to be greater after radiotherapy (19% versus 15 %), but with less chronic lymphoedema (16% versus 22%).Conclusions: There is only very low-quality evidence on administering adjuvant radiotherapy for inguinal lymph node metastases. Even though the identified study was a multicenter RCT, there was a reasonable imprecision and inconsistency because of small study numbers, wide confidence intervals in the data and early trial closure, resulting in downgrading of the evidence.