De-radicalizing Cancer Therapy

Vulvar cancer sentinel lymph node biopsies can replace lymphadenectomy

(RxWiki News) A sentinel lymph node biopsy removes the lymph node closest to a tumor. The goal is to see if cancer has spread to the lymph nodes that filter out foreign particles from the body. This is a common procedure during breast cancer and melanoma surgeries.

Sentinel node biopsies may be a safe alternative to removing all groin lymph nodes in select women with vulvar cancer.

Groin lymph node removal, which is known as inguinal femoral lymphadenectomy, has a number of serious adverse effects ranging from initial wound healing difficulties to lymph node swelling (lymphedema) that can last a lifetime.

"Ask your surgeon to explain the details of your operation."

Charles F. Levenback, MD, professor in the Department of Gynecologic Oncology at The University of Texas MD Anderson Cancer Center, led the study.

Researchers enrolled a total of 452 women who had the most common form of vulvar cancer - squamous cell carcinoma. They all had tumors that ranged in size from 2 cm (quarter-sized) to 4 cm (nearly 2.5 inches).

The women each had procedures that mapped the location of lymph nodes, a sentinel lymph node biopsy (SLNB) and removal of lymph nodes in the groin.

A total of 418 women had at least one sentinel lymph node (SNL) detected. And of this group, 31.6 percent of the women had cancer that had spread, or metastasized to the lymph nodes.

Nearly 25 percent of the positive (cancerous) nodes were detected using a staining method that picks up abnormal cells.

These results are similar to the findings of the GROINS V (Gronigen International Sentinel Nodes Vulva) study conducted in the Netherlands.

"We believe that the results of this trial coupled with the results of the GROINS V study provide adequate evidence that SLNB should be offered to well-selected patients by well-trained and informed gynecologic oncologists," the authors wrote.

They cautioned, "In clinical settings where vulvar cancer is rare and surgeons’ experience is limited, referral to a high-volume center or surgeon is appropriate."

Vulvar cancer is rare, affecting about 4,500 women a year in the U.S. The disease overwhelms about 1,000 women every year.

This research was published July 2, in the Journal of Clinical Oncology. The National Cancer Institute supported this study; authors declared no conflicts of interest. 

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Review Date: 
August 8, 2012