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

Francesco Raspagliesi, Flavia Zanaboni, Fabio Martinelli, Santiago Scasso, Joel Laufer, Antonino Ditto

Research output: Contribution to journalArticle

17 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)22-29
Number of pages8
JournalJournal of Gynecologic Oncology
Volume25
Issue number1
DOIs
Publication statusPublished - Jan 2014

Fingerprint

Neoadjuvant Therapy
Vulva
Squamous Cell Carcinoma
Vulvar Neoplasms
Ifosfamide
Drug Therapy
Carcinoma in Situ
Granulocyte Colony-Stimulating Factor
Thigh
TP protocol
Lymph Node Excision
Disease-Free Survival
Survivors
Neoplasms
Therapeutics
Bone Marrow
Radiation
Morbidity
Recurrence

Keywords

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

ASJC Scopus subject areas

  • Obstetrics and Gynaecology
  • Oncology

Cite this

Role of paclitaxel and cisplatin as the neoadjuvant treatment for locally advanced squamous cell carcinoma of the vulva. / Raspagliesi, Francesco; Zanaboni, Flavia; Martinelli, Fabio; Scasso, Santiago; Laufer, Joel; Ditto, Antonino.

In: Journal of Gynecologic Oncology, Vol. 25, No. 1, 01.2014, p. 22-29.

Research output: Contribution to journalArticle

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