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

Journal of Gynecologic Oncology 2014년 25권 1호 p.22 ~ p.29

(Raspagliesi Francesco) - Fondazione IRCCS Istituto Nazionale dei Tumori Gynecologic Oncology Unit
(Zanaboni Flavia) - Fondazione IRCCS Istituto Nazionale dei Tumori Gynecologic Oncology Unit
(Martinelli Fabio) - Fondazione IRCCS Istituto Nazionale dei Tumori Gynecologic Oncology Unit
(Scasso Santiago) - Fondazione IRCCS Istituto Nazionale dei Tumori Gynecologic Oncology Unit
(Laufer Joel) - Fondazione IRCCS Istituto Nazionale dei Tumori Gynecologic Oncology Unit
(Ditto Antonino) - Fondazione IRCCS Istituto Nazionale dei Tumori Gynecologic Oncology Unit

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.