Journal article
Surgical Margins After Neoadjuvant Radiation for Locally Advanced Vulvar Carcinoma: What is an Adequate Margin?
American journal of clinical oncology, v 47(11)
08 Jul 2024
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Objective: We aim to explore whether the surgical tumor free margin is important for overall survival (OS) and local control in patients who undergo neoadjuvant radiation (RT) for vulvar cancer. Methods: A retrospective review from 2004 to 2021 of patients who underwent RT followed by surgical resection was performed. Patients were categorized into groups based on margin status (no residual disease, >8 mm, close margins defined as 1 to 7 mm, or positive). Local control and OS were analyzed using the Kaplan-Meier with log rank test. Multivariate analysis was performed with cox hazards model. Results: Eighty-three patients were included. A complete pathologic response (pCR) was found in 56% (n=46) of patients. The median follow-up time was 35 months (range: 4 to 216). The median OS for the entire cohort was 46 months (95% CI: 32.3-59.7). Having a pCR improved both OS and disease-free survival (DFS) compared with residual disease by 81 and 91 months, respectively ( P <0.001). In the 2 patients with a margin >8 mm, there was no statistical difference in survival between those with close margins (46 vs. 25 mo, P =0.485). Factors that significantly impacted both OS and DFS were depth of invasion (DOI) and LVSI. On multivariate analysis of those with residual disease, there was no difference in OS or DFS by margin status but having a DOI >9 mm showed decreased OS (HR: 3.654; 95% CI: 1.317-10.135). Conclusions: In this cohort, response to RT, not margin status drives survival and recurrence. Given residual disease, the optimal margin is not clear, as there were only 2 patients with >8 mm margins. A close or positive margin had no impact on OS or local recurrence. A DOI >9 mm significantly impacts both OS and local recurrence even when accounting for other factors.
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Details
- Title
- Surgical Margins After Neoadjuvant Radiation for Locally Advanced Vulvar Carcinoma
- Creators
- Michelle Ertel - Department of Obstetrics and Gynecology, Magee Women’s HospitalJohn A. Vargo - University of Pittsburgh Medical CenterAnna Weimer - Department of Obstetrics and Gynecology, Magee Women’s HospitalAdam Richman - Unity Health SystemSushil Beriwal - Allegheny Health NetworkMohammed Mohammed - University of Pittsburgh Medical CenterJaime Lesnock - Department of Obstetrics and Gynecology, Magee Women’s Hospital
- Publication Details
- American journal of clinical oncology, v 47(11)
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS; PHILADELPHIA
- Number of pages
- 6
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Radiation Oncology (and Nuclear Medicine)
- Web of Science ID
- WOS:001340497800007
- Scopus ID
- 2-s2.0-85197799639
- Other Identifier
- 991021897364404721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Oncology