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Radiation Therapy
from Section VI - Vaginal and Vulvar Cancer
Published online by Cambridge University Press: 20 July 2023
Sentinel lymph node (SLN) biopsy is now the standard of care over inguinofemoral lymphadenectomy (IFL) in properly selected patients with early-stage squamous cell carcinoma (SCC) of the vulva. Patients with negative SLN do well without further intervention. However, a standardized treatment paradigm following the findings of a positive SLN remains lacking. Based on results from the GROINSS-V-II trial, patients with a micrometastasis of ≤2 mm receiving adjuvant inguinofemoral radiation therapy had a two-year ipsilateral isolated groin recurrence rate of 1.6%, and can avoid the morbidity of complete inguinofemoral lymphadenectomy (IFL). The approach for patients with SLN macrometastases (>2 mm) remains undefined – if such patients are treated without further IFL, careful attention to radiation treatment planning, dose, and the addition of concurrent cisplatin-based chemotherapy should be considered.
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