Analysis of Clinico-Pathological Profile and Treatment Outcome in Postoperative Patients of Vulvar Carcinoma in a Tertiary Care Centre.
Journal Title: International Journal of Medical Science and Innovative Research (IJMSIR) - Year 2017, Vol 2, Issue 6
Abstract
Aims and objective: To analyze the clinico-pathological data and to correlate outcome of the disease in cancer vulva patients treated by primary surgery. Material and methods: 65 cases of vulvar cancer patients attending gynaecologic-oncology OPD and treated with primary surgery were analysed over a period of 16 years from 2001 to 2016. Two cases diagnosed with sarcoma and melanoma was included as a separate entity for analysis. Results: In the present study, incidence of vulvar cancer was 3.02% among all gynaecological malignancies with the median age of presentation being 54 years. 95.38%(62/65) of vulvar cancers were squamous cell histology with predominant well differentiated grading (61.29%). The median tumour size was 3.7 cm. The incidence of stage-I, -II, -III and –IV diseases were 1.59%, 73.02%, 23.80%, and 1.59% respectively. Radical vulvectomy and lymph node dissection was performed in 98.4%(62/63) and 88.89%(56/63) cases respectively and 49.21% patients received adjuvant treatment. Complications were seen in 53.9%(34/63) cases with wound infection being the most common. The median follow-up period was 60 months. Out of 65 , 50 patients returned for follow-up. Local or regional recurrence occurred in 32%(16/50) cases. Majority recurred within 2-years of follow-up and in stage-III, margin positive, and cases who did not undergo lymph node dissection. The overall survival of patients with negative and positive lymph node was 42.22 months and 20.004 months respectively. This difference was statistically significant (P VALUE= 0.021) .Overall survival with regard to tumour size and adjuvant therapy was not statistically significant. Conclusion: The study concluded that, in order to improve outcome, radical vulvectomy and lymph node dissection should be the initial treatment for vulvar cancer along with the use of flap to improve body image and prevent wound breakdown. Adjuvant radiotherapy should be considered in margin positive, lymph node positive, or stage-III/IV cases. Age, tumour size, stage, margin and lymph node are the independent prognostic factors. The role of neoadjuvant/definitive concurrent chemoradiation needs further evaluation.
Authors and Affiliations
Nitish Ranjan Acharya
Keywords
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