J Gynecol Oncol.  2014 Jan;25(1):22-29. 10.3802/jgo.2014.25.1.22.

Role of paclitaxel and cisplatin as the neoadjuvant treatment for locally advanced squamous cell carcinoma of the vulva

• Raspagliesi F
• Zanaboni F
• Martinelli F
• Scasso S
• Laufer J
• Ditto A

• KMID: 1811184
• DOI: http://doi.org/10.3802/jgo.2014.25.1.22

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.

Keyword

Locally advanced vulvar cancer; Morbidity; Neoadjuvant chemotherapy; Paclitaxel and cisplatin; Surgical treatment

MeSH Terms

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
Cisplatin
Ifosfamide
Paclitaxel

Figure

• 

  Fig. 1 Vulvar neoplasia T2N2 before treatment (A) and partial response after 3 courses of neoadjuvant chemotherapy (pT1b pN0) (B).

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