Role of adjuvant radiation or re-excision for early stage vulvar squamous cell carcinoma with positive or close surgical margins

Sabrina M. Bedell; C. Hedberg; Anna Griffin; Hannah Pearson; Annelise Wilhite; Nathan T Rubin; Britt K Erickson

doi:10.1016/j.ygyno.2019.05.028

Role of adjuvant radiation or re-excision for early stage vulvar squamous cell carcinoma with positive or close surgical margins

Sabrina M. Bedell, C. Hedberg, Anna Griffin, Hannah Pearson, Annelise Wilhite, Nathan T Rubin, Britt K Erickson

Research output: Contribution to journal › Article › peer-review

12 Scopus citations

Abstract

OBJECTIVES: This study aims to evaluate whether re-excision or adjuvant radiation for stage I vulvar squamous cell carcinoma (SCC) with either a close or positive surgical margin improves recurrence-free survival.

METHODS: Patients with pathologically confirmed FIGO stage I vulvar SCC who underwent primary surgical management between January 1, 1995 and September 30, 2017 and had positive or close (<8 mm) surgical margins were included. Kaplan-Meier curves were generated and compared using the log-rank test.

RESULTS: Of 150 patients with stage I vulvar SCC, 47 (31.3%) had positive or close margins. Median follow-up time was 25 months (IQR 13-59 months). Twenty-one (44.6%) patients received additional treatment with re-excision (n = 17) or vulvar radiation (n = 4); 26 (55.3%) patients received no additional therapy. Patients with positive margins were more likely to receive additional therapy compared to patients with close margins (80% vs 35.1%, p = 0.03). The 2-year recurrence rates were similar between the no further therapy and the re-excision/vulvar radiation groups (11.5% vs 4.8%, p = 0.62). Local recurrence-free survival (RFS) and overall survival (OS) were similar between patients who received re-excision/vulvar radiation and patients who received no further therapy (p = 0.10 and p = 0.16, respectively). Subgroup analysis of the 37 patients with close margins demonstrated no difference in RFS or OS when patients received re-excision or adjuvant vulvar radiation compared to no additional therapy (p = 0.74 and p = 0.82, respectively).

CONCLUSIONS: In our study, any additional treatment following primary surgical resection did not improve RFS or OS in stage IA and IB vulvar SCC. Larger studies are warranted in order to definitively determine the role of re-excision and adjuvant radiation in early stage disease.

Original language	English (US)
Pages (from-to)	276-279
Number of pages	4
Journal	Gynecologic oncology
Volume	154
Issue number	2
DOIs	https://doi.org/10.1016/j.ygyno.2019.05.028
State	Published - Aug 2019

Bibliographical note

Funding Information:
Research reported in this publication was supported by NIH grant P30 CA77598 utilizing the Biostatistics and Bioinformatics Core shared resource of the Masonic Cancer Center, University of Minnesota and by the National Center for Advancing Translational Sciences of the National Institutes of Health Award Number UL1TR000114. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Publisher Copyright:
© 2019 Elsevier Inc.

Keywords

Adjuvant radiation
Close margins
Early stage
Re-excision
Squamous cell carcinoma
Vulva
Reoperation
Neoplasm Recurrence, Local/mortality
Humans
Middle Aged
Margins of Excision
Proportional Hazards Models
Case-Control Studies
Disease-Free Survival
Vulvar Neoplasms/mortality
Radiotherapy, Adjuvant/methods
Time Factors
Aged, 80 and over
Carcinoma, Squamous Cell/mortality
Female
Aged
Retrospective Studies

PubMed: MeSH publication types

Journal Article
Research Support, N.I.H., Extramural
Evaluation Study

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Publisher link

10.1016/j.ygyno.2019.05.028

Find It

Find It at U of M Libraries

Cite this

@article{04a6deb5f7bd465c832d23e80e6e3078,

title = "Role of adjuvant radiation or re-excision for early stage vulvar squamous cell carcinoma with positive or close surgical margins",

abstract = "OBJECTIVES: This study aims to evaluate whether re-excision or adjuvant radiation for stage I vulvar squamous cell carcinoma (SCC) with either a close or positive surgical margin improves recurrence-free survival.METHODS: Patients with pathologically confirmed FIGO stage I vulvar SCC who underwent primary surgical management between January 1, 1995 and September 30, 2017 and had positive or close (<8 mm) surgical margins were included. Kaplan-Meier curves were generated and compared using the log-rank test.RESULTS: Of 150 patients with stage I vulvar SCC, 47 (31.3%) had positive or close margins. Median follow-up time was 25 months (IQR 13-59 months). Twenty-one (44.6%) patients received additional treatment with re-excision (n = 17) or vulvar radiation (n = 4); 26 (55.3%) patients received no additional therapy. Patients with positive margins were more likely to receive additional therapy compared to patients with close margins (80% vs 35.1%, p = 0.03). The 2-year recurrence rates were similar between the no further therapy and the re-excision/vulvar radiation groups (11.5% vs 4.8%, p = 0.62). Local recurrence-free survival (RFS) and overall survival (OS) were similar between patients who received re-excision/vulvar radiation and patients who received no further therapy (p = 0.10 and p = 0.16, respectively). Subgroup analysis of the 37 patients with close margins demonstrated no difference in RFS or OS when patients received re-excision or adjuvant vulvar radiation compared to no additional therapy (p = 0.74 and p = 0.82, respectively).CONCLUSIONS: In our study, any additional treatment following primary surgical resection did not improve RFS or OS in stage IA and IB vulvar SCC. Larger studies are warranted in order to definitively determine the role of re-excision and adjuvant radiation in early stage disease.",

keywords = "Adjuvant radiation, Close margins, Early stage, Re-excision, Squamous cell carcinoma, Vulva, Reoperation, Neoplasm Recurrence, Local/mortality, Humans, Middle Aged, Margins of Excision, Proportional Hazards Models, Case-Control Studies, Disease-Free Survival, Vulvar Neoplasms/mortality, Radiotherapy, Adjuvant/methods, Time Factors, Aged, 80 and over, Carcinoma, Squamous Cell/mortality, Female, Aged, Retrospective Studies",

author = "Bedell, {Sabrina M.} and C. Hedberg and Anna Griffin and Hannah Pearson and Annelise Wilhite and Rubin, {Nathan T} and Erickson, {Britt K}",

note = "Funding Information: Research reported in this publication was supported by NIH grant P30 CA77598 utilizing the Biostatistics and Bioinformatics Core shared resource of the Masonic Cancer Center, University of Minnesota and by the National Center for Advancing Translational Sciences of the National Institutes of Health Award Number UL1TR000114. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Publisher Copyright: {\textcopyright} 2019 Elsevier Inc.",

year = "2019",

month = aug,

doi = "10.1016/j.ygyno.2019.05.028",

language = "English (US)",

volume = "154",

pages = "276--279",

journal = "Gynecologic oncology",

issn = "0090-8258",

publisher = "Academic Press Inc.",

number = "2",

}

TY - JOUR

T1 - Role of adjuvant radiation or re-excision for early stage vulvar squamous cell carcinoma with positive or close surgical margins

AU - Bedell, Sabrina M.

AU - Hedberg, C.

AU - Griffin, Anna

AU - Pearson, Hannah

AU - Wilhite, Annelise

AU - Rubin, Nathan T

AU - Erickson, Britt K

N1 - Funding Information: Research reported in this publication was supported by NIH grant P30 CA77598 utilizing the Biostatistics and Bioinformatics Core shared resource of the Masonic Cancer Center, University of Minnesota and by the National Center for Advancing Translational Sciences of the National Institutes of Health Award Number UL1TR000114. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Publisher Copyright: © 2019 Elsevier Inc.

PY - 2019/8

Y1 - 2019/8

N2 - OBJECTIVES: This study aims to evaluate whether re-excision or adjuvant radiation for stage I vulvar squamous cell carcinoma (SCC) with either a close or positive surgical margin improves recurrence-free survival.METHODS: Patients with pathologically confirmed FIGO stage I vulvar SCC who underwent primary surgical management between January 1, 1995 and September 30, 2017 and had positive or close (<8 mm) surgical margins were included. Kaplan-Meier curves were generated and compared using the log-rank test.RESULTS: Of 150 patients with stage I vulvar SCC, 47 (31.3%) had positive or close margins. Median follow-up time was 25 months (IQR 13-59 months). Twenty-one (44.6%) patients received additional treatment with re-excision (n = 17) or vulvar radiation (n = 4); 26 (55.3%) patients received no additional therapy. Patients with positive margins were more likely to receive additional therapy compared to patients with close margins (80% vs 35.1%, p = 0.03). The 2-year recurrence rates were similar between the no further therapy and the re-excision/vulvar radiation groups (11.5% vs 4.8%, p = 0.62). Local recurrence-free survival (RFS) and overall survival (OS) were similar between patients who received re-excision/vulvar radiation and patients who received no further therapy (p = 0.10 and p = 0.16, respectively). Subgroup analysis of the 37 patients with close margins demonstrated no difference in RFS or OS when patients received re-excision or adjuvant vulvar radiation compared to no additional therapy (p = 0.74 and p = 0.82, respectively).CONCLUSIONS: In our study, any additional treatment following primary surgical resection did not improve RFS or OS in stage IA and IB vulvar SCC. Larger studies are warranted in order to definitively determine the role of re-excision and adjuvant radiation in early stage disease.

AB - OBJECTIVES: This study aims to evaluate whether re-excision or adjuvant radiation for stage I vulvar squamous cell carcinoma (SCC) with either a close or positive surgical margin improves recurrence-free survival.METHODS: Patients with pathologically confirmed FIGO stage I vulvar SCC who underwent primary surgical management between January 1, 1995 and September 30, 2017 and had positive or close (<8 mm) surgical margins were included. Kaplan-Meier curves were generated and compared using the log-rank test.RESULTS: Of 150 patients with stage I vulvar SCC, 47 (31.3%) had positive or close margins. Median follow-up time was 25 months (IQR 13-59 months). Twenty-one (44.6%) patients received additional treatment with re-excision (n = 17) or vulvar radiation (n = 4); 26 (55.3%) patients received no additional therapy. Patients with positive margins were more likely to receive additional therapy compared to patients with close margins (80% vs 35.1%, p = 0.03). The 2-year recurrence rates were similar between the no further therapy and the re-excision/vulvar radiation groups (11.5% vs 4.8%, p = 0.62). Local recurrence-free survival (RFS) and overall survival (OS) were similar between patients who received re-excision/vulvar radiation and patients who received no further therapy (p = 0.10 and p = 0.16, respectively). Subgroup analysis of the 37 patients with close margins demonstrated no difference in RFS or OS when patients received re-excision or adjuvant vulvar radiation compared to no additional therapy (p = 0.74 and p = 0.82, respectively).CONCLUSIONS: In our study, any additional treatment following primary surgical resection did not improve RFS or OS in stage IA and IB vulvar SCC. Larger studies are warranted in order to definitively determine the role of re-excision and adjuvant radiation in early stage disease.

KW - Adjuvant radiation

KW - Close margins

KW - Early stage

KW - Re-excision

KW - Squamous cell carcinoma

KW - Vulva

KW - Reoperation

KW - Neoplasm Recurrence, Local/mortality

KW - Humans

KW - Middle Aged

KW - Margins of Excision

KW - Proportional Hazards Models

KW - Case-Control Studies

KW - Disease-Free Survival

KW - Vulvar Neoplasms/mortality

KW - Radiotherapy, Adjuvant/methods

KW - Time Factors

KW - Aged, 80 and over

KW - Carcinoma, Squamous Cell/mortality

KW - Female

KW - Aged

KW - Retrospective Studies

UR - http://www.scopus.com/inward/record.url?scp=85066407880&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85066407880&partnerID=8YFLogxK

U2 - 10.1016/j.ygyno.2019.05.028

DO - 10.1016/j.ygyno.2019.05.028

M3 - Article

C2 - 31171409

AN - SCOPUS:85066407880

SN - 0090-8258

VL - 154

SP - 276

EP - 279

JO - Gynecologic oncology

JF - Gynecologic oncology

IS - 2

ER -

Role of adjuvant radiation or re-excision for early stage vulvar squamous cell carcinoma with positive or close surgical margins

Abstract

Bibliographical note

Keywords

PubMed: MeSH publication types

UN SDGs

Publisher link

Find It

Other files and links

Fingerprint

Cite this