The need for pelvic treatment in patients with node-positive vulvar cancer (VSCC) and the value of pelvic lymphadenectomy (LAE) as a staging procedure to plan adjuvant radiotherapy (RT) is controversial. In this retrospective, multicenter analysis, 306 patients with primary node-positive VSCC treated at 33 gynecologic oncology centers in Germany between 2017 and 2019 were analyzed. All patients received surgical staging of the groins; nodal status was as follows: 23.9% (73/306) pN1a, 23.5% (72/306) pN1b, 20.4% (62/306) pN2a/b, and 31.9% (97/306) pN2c/pN3. A total of 35.6% (109/306) received pelvic LAE; pelvic nodal involvement was observed in 18.5%. None of the patients with nodal status pN1a or pN1b and pelvic LAE showed pelvic nodal involvement. Taking only patients with nodal status ≥pN2a into account, the rate of pelvic involvement was 25%. In total, adjuvant RT was applied in 64.4% (197/306). Only half of the pelvic node-positive (N+) patients received adjuvant RT to the pelvis (50%, 10/20 patients); 41.9% (122/291 patients) experienced recurrent disease or died. In patients with histologically-confirmed pelvic metastases after LAE, distant recurrences were most frequently observed (7/20 recurrences). Conclusions: A relevant risk regarding pelvic nodal involvement was observed from nodal status pN2a and higher. Our data support the omission of pelvic treatment in patients with nodal status pN1a and pN1b.

Hintergrund Die Notwendigkeit einer pelvinen Therapie bei Patientinnen mit nodal-positivem Vulvakarzinom (VSCC) und der Stellenwert der pelvinen Lymphonodektomie (LNE) als Staging-Verfahren zur Planung der adjuvanten Strahlentherapie (RT) sind umstritten.

Hintergrund: Die Publikation der S2k-Leitlinie im Jahr 2015 veränderte die Empfehlungen zur pelvinen Lymphonodektomie (pLAE) bei VSCC grundlegend: Demnach wird pLAE für alle Patientinnen mit Risikofaktoren für einen pelvinen Lymphknoten (LK)-Befall empfohlen. Diese Risikofaktoren sind jedoch nicht eindeutig definiert, und die postoperative Morbidität ist hoch.

Since the publication of the updated German guideline in 2015, the recommendations for performing pelvic lymphadenectomy (LAE) in patients with vulvar cancer (VSCC) have changed considerably. The guideline recommends surgical lymph node staging in all patients with a higher risk of pelvic lymph node involvement. However, the current data do not allow the population at risk to be clearly defined, therefore, the indication for pelvic lymphadenectomy is still not clear. There are currently two published German patient popula-tions who had pelvic LAE which can be used to investigate both the prognostic effect of histologically verified pelvic lymph node metastasis and the relation between inguinal and pelvic lymph node involvement. A total of 1618 patients with primary FIGO stage ≥ IB VSCC were included in the multi-center AGO CaRE-1 study (1998 – 2008), 70 of whom underwent pelvic LAE. During a retrospective single-center evaluation carried out at the University Medical Center Hamburg-Eppendorf (UKE), a total of 514 patients with

Background The recommendation for pelvic lymphadenectomy (LAE) in VSCC has changed fundamentally since the S2k-Guideline was published in 2015; herein LAE in patients at risk for pelvic nodal involvement is advised. However, the population at risk is poorly defined.

Introduction/Background Today, there are two accepted pathways for tumorigenesis of vulvar squamous cell carcinoma (VSCC): an HPV-dependent with p16 overexpression as a surrogate for HPV-associated transformation and an HPV-independent route linked to lichen sclerosus, characterized by p53 mutation. A possible correlation of HPV dependency with a favourable prognosis has been proposed. Methodology The AGO CaRE-1 study is a retrospective survey of pts with primary VSCC FIGO stage ≥1B (UICC-TNM version 6) treated at 29 gynecologic cancer centers in Germany 1998–2008 (n=1,618). For this CaRE-translational sub-study available FFPE tissue was collected centrally (n=648). A tissue micro array (TMA) was constructed; p16 and p53 expression was determined by immunohistochemistry (IHC). HPV status and subtype were analyzed by PCR. Results p16 IHC was interpretable in 550 TMA spots and considered positive in 166/550 (30.2%). HPV DNA was detected in 78.4% of the p16+ tumors, with HPV 16 being the most common subtype (88.3%). p53 IHC was interpretable in 597 spots, 187/597 (31.3%) were considered positive. Pts with p53+ tumors were older at first diagnosis (71 vs. 66 yrs; p=0.001 for p53- tumors) and showed lymph-node involvement more often (43.3% vs. 31.1%; p=0.007). There was a relevant number of tumors with neither p16 nor p53 overexpression (221/535); while co-expression of p53 and p16 was rare (12/535). For survival analyses, three groups were defined: p53+ (n=163), p16+/p53- (n=151) and p16-/p53- (n=221). 2-y-disease-free (DFS) and overall survival (OS) rates were significantly different between the groups: DFS: p53+ 47.0%; p16-/p53- 53% and p16+/p53- 65.5% (p<0.001); OS: 70.4%, 72.6% and 82.7% (p=0.003), respectively. Adjustment for age and nodal status showed consistent p16 and p53 effects regarding DFS. Conclusion p16 overexpression is associated with an improved prognosis in VSCC while p53 positivity is linked to an adverse outcome. Our data provide evidence of a clinically. Disclosure The AGO CaRE translational study was supported by medac oncology without restrictions in the study protocol.

Zielsetzung: Die Sentinellymphonodektomie (SLND) stellt eine Alternative zur radikalen inguinofemoralen Lymphonodektomie (LND) beim Vulvakarzinom dar. In der vorliegenden Analyse werden die beiden operativen Konzepte als Subgruppenanalyse der großen multizentrischen AGO-CaRE-1 Studie verglichen.

Hintergund/Zielsetzung: Abhängig vom Lymphknotenstatus entwickeln 15 – 40% der Patientinnen mit Vulvakarzinom ein Lokalrezidiv. Ein isoliertes Rezidiv im Bereich der Vulva gilt dabei als wenig relevant für die weitere Prognose.

Purpose: This is an official guideline, published and coordinated by the Arbeitsgemeinschaft Gynäkologische Onkologie (AGO, Study Group for Gynecologic Oncology) of the Deutsche Krebsgesellschaft (DKG, German Cancer Society) and the Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG, German Society for Gynecology and Obstetrics). The number of cases with vulvar cancer is on the rise, but because of the former rarity of this condition and the resulting lack of literature with a high level of evidence, in many areas knowledge of the optimal clinical management still lags behind what would be required. This updated guideline aims to disseminate the most recent recommendations, which are much clearer and more individualized, and is intended to create a basis for the assessment and improvement of quality care in hospitals. Methods: This S2k guideline was drafted by members of the AGO Committee on Vulvar and Vaginal Tumors; it was developed and formally completed in accordance with the structured consensus process of the Association of Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF). Recommendations: 1. The incidence of disease must be taken into consideration. 2. The diagnostic pathway, which is determined by the initial findings, must be followed. 3. The clinical and therapeutic management of vulvar cancer must be done on an individual basis and depends on the stage of disease. 4. The indications for sentinel lymph node biopsy must be evaluated very carefully. 5. Follow-up and treatment for recurrence must be adapted to the individual case.

Wegen der relativen Seltenheit der Erkrankungen werden die diagnostischen Maßnahmen bei Tumoren der Vulva und Vagina immer wieder hinterfragt.

Fragestellung: Diese Subgruppenanalyse der AGO-CaRE-1 Studie untersucht den Einfluss des pathologischen Resektionsrandes auf das Rezidivrisiko beim Vulvakarzinom. Hintergrund ist die Infragestellung des derzeitigen Standards von 8 mm durch kleinere Fallserien.

Anamnese: 30-jährige IG, spontane Konzeption, regelmäßige Zyklen, unauffällige gynäkologische und allgemeinmedizinische Vorgeschichte

Die perinatale Morbidität und Mortalität ist beiMehrlingsschwangerschaften erhöht. Monochoriale (MC) Gemini weisen eine zwei- bzw. vierfach höhere perinatale Mortalitätsrate als dichoriote Gemini bzw. Einlinge auf. Monoamniote Mehrlingsschwangerschaften tragen hierbei das höchste perinatale Risiko.

Daten sowohl von klinischen als auch pathologischen Studien der letzten Jahre haben eine Überarbeitung der TNM-Klassifikation gynäkologischer Tumoren notwendig gemacht. Die grundlegendste Überarbeitung erfolgte beim Vulvakarzinom. Hier wurde die alleinige Bedeutung der Tumorgröße durch andere Parameter ergänzt. Die Zahl metastatisch befallener regionärer Lymphknoten hat Eingang in das Staging gefunden. Beim Zervixkarzinom wird die Kategorie T2a anhand der Tumorgröße mit einem Grenzwert von ≤4 cm vs. >4 cm unterteilt in T2a1 und T2a2. Beim Endometriumkarzinom erfolgte die Neuordnung der Kategorie T1 (Tumoren auf das Corpus uteri beschränkt) sowie eine neue Definition der Kategorie T2. Für Uterussarkome (Leiomyosarkome, endometriale Stromasarkome/Adenosarkome) wurde erstmals eine TNM-Klassifikation eingeführt.