Neoadjuvant Chemotherapy in Vulvar Cancer: Avoiding Primary Exenteration

Objective. To determine whether neoadjuvant cisplatin and 5-flourouracil chemotherapy can be used to preserve the trial sphincter and/or urethra in patients with advanced vulvar cancer involving these sites.Methods. Fourteen patients with advanced vulvar cancer (1997-2003) involving the anal sphincter and/or urethra were given 3-4 cycles of neoadjuvant chemotherapy to attempt preservation of these pelvic structures rather than undergoing a primary pelvic exenteration. Following 3 cycles, a radical vulvectomy and groin lymph node dissection were planned. All patients had lesion size documented by measurement and photograph prior to and following chemotherapy.Results. The median age was 63 years (range 39-88). Thirteen patients received a median of 3 cycles (range 2-4) of neoadjuvant chemotherapy. Ten patients received cisplatin and 5-flourouracil, while three received cisplatin alone. The median time from diagnosis to Surgery was 77 days (range 54-143). All patients with cisplatin and 5-flourouracil chemotherapy underwent surgery except one patient who had a synchronous renal cell carcinoma and died prior to surgery. Patients receiving cisplatin alone showed no measurable response, while all patients receiving cisplatin and 5-flourouracil demonstrated at least a partial response. Two patients had no residual invasive carcinoma on final pathology. All patients receiving cisplatin and 5-flourouracil followed by surgery are disease-free, while two of three receiving cisplatin have progressive disease. The anal sphincter and urethra were conserved in all patients receiving cisplatin and 5-flourouracil.Conclusion. Neoadjuvant cisplatin and 5-flourouracil in advanced vulvar cancer demonstrated a response rate of 100%. The anal sphincter and urethra were conserved in all patients receiving cisplatin and 5-fluorouracil. Responders are disease-free at this time.This response rate demonstrates superior activity of 5-flourouracil in vulvar cancer and spares these patients the morbidity of exenteration or radiation.(c) 2005 Elsevier Inc. All rights reserved.