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Vulva - Tumoren: Therapie

Allgemeines

 

Operation

 Radikale Vulvektomie inguino-femorale Lymphonodektomie Sentinel-Lymphonodektomie
Schmetterlings-Inzision nach Way (3,4,5)
Schmetterlings-Inzision
Wegen der häufigen Wundkomplikationen kaum noch angewendet.

Radiatio

Chemotherapie

Imiquimod

Therapie der HPV-assoziierten VIN

offene Protokolle

Quellen

1.) AGO
Interdisziplinäre S2k-Leitlinie für die Diagnostik und Therapie des Vulvakarzinoms und seiner Vorstufen.
Zuckschwerdt Verlag, München 2009

2.) Beriwal S, et al.:
Preoperative Intensity Modulated Radiation Therapy and Chemotherapy for Locally Advanced Vulvar Carcinoma: Analysis of Pattern of Relapse.
Int J Radiation Oncol Biol Phys 2013;85:1269-1274
http://dx.doi.org/10.1016/j.ijrobp.2012.11.012

3.) Way S:
The anatomy of the lymphatic drainage of the vulva and its influence on the radical operation for carcinoma.
Ann R Coll Surg Eng 1948;3:187

4.) Way S:
Carcinoma of the vulva.
Am J Obstet Gynecol 1960;79:692-698

5.) Way S:
The surgery of vulval carcinoma:an appraisal.
Clin Obstet Gynecol 1978;5:627

Impressum .....................................................................................Zuletzt geändert am 28.08.2017 16:13

Gyn Oncol 2015;137:365–372 Impact of adjuvant chemotherapy with radiation for node-positive vulvar cancer: A National Cancer Data Base (NCDB) analysis☆ Beant S. Gill , Mark E. Bernard , Jeff F. Lin , Goundappa K. Balasubramani , Malolan S. Rajagopalan , Paniti Sukumvanich , Thomas C. Krivak , Alexander B. Olawaiye , Joseph L. Kelley , Sushil Beriwal'Correspondence information about the author Sushil BeriwalEmail the author Sushil Beriwal DOI: http://dx.doi.org/10.1016/j.ygyno.2015.03.056 | showArticle Info Abstract Full Text Images References Highlights •Utilization of adjuvant chemotherapy for node-positive vulvar cancer is increasing. •Adjuvant chemotherapy improved survival following surgery and radiation. AbstractBackground For node-positive vulvar cancer, adjuvant radiotherapy has an established benefit, whereas the impact of chemotherapy is unknown. A National Cancer Data Base (NCDB) analysis was conducted to determine patterns of care and evaluate the survival impact of adjuvant chemotherapy. Methods The NCDB was queried for vulvar cancer patients diagnosed from 1998–2011 who underwent extirpative surgery with confirmed inguinal nodal involvement treated with adjuvant radiotherapy. Patients with inadequate follow-up or non-squamous histologies were excluded. Chi-square test, logistic regression analysis, log-rank test and multivariable Cox proportional regression modeling with adjustment using propensity score with inverse probability of treatment weights (IPTW) were conducted to establish factors associated with utilization and survival. Results A total of 1797 patients were identified: 26.3% received adjuvant chemotherapy and 76.6% had 1–3 involved lymph nodes. Adoption of adjuvant chemotherapy significantly increased over time, from 10.8% in 1998 to 41.0% in 2006 (p < 0.001). Lower utilization was seen in older patients, Northeast or Southern facilities, and patients with more extensive nodal dissection, whereas greater number of involved nodes, stage IVA disease and positive surgical margins led to a higher probability of receiving chemotherapy. Unadjusted median survival without and with adjuvant chemotherapy was 29.7 months and 44.0 months (p = 0.001). On IPTW-adjusted Cox proportional regression modeling, delivery of adjuvant chemotherapy resulted in a 38% reduction in the risk of death (HR 0.62, 95% CI 0.48–0.79, p < 0.001). Conclusion In a large population-based analysis, adjuvant chemotherapy resulted in a significant reduction in mortality risk for node-positive vulvar cancer patients who received adjuvant radiotherapy.