Toxicity Profile In Patients Submitted To New Strategy For The Treatment Of Vulvar Cancer Employing Sentinel Lymph Node Scintigraphy, Surgery, Chemotherapy, And Radiotherapy

Objectives To evaluate the toxicity in patients submitted to a new multimodality treatment for vulvar cancer (VC), combining sentinel lymphoscintigraphy, chemotherapy (CT), radiotherapy (RT), and surgery in a way as yet untested, presumably capable of reducing treatment morbidity and functional and esthetic damage, as well as gaining locoregional control. Methods From 2011 to 2019, patients from the Outpatient Clinic of Gynecological Oncology, Cancer Institute, Sao Paulo State (ICESP) with VC (early and advanced stages) were included in a prospective trial. All patients with tumors up to 4 cm in greatest diameter, uncompromised urethra or anus, and lymph nodes smaller than 15 mm in greatest diameter were considered early-stage. Any other cases were deemed advanced and underwent inguinal-femoral lymphadenectomy, then cisplatin once a week for 7 weeks concomitant to iguinal-pelvic RT. Surgery was performed 30–120 days after CTRT. We conducted a restrospective analysis to evaluate treatment toxicity, using the common toxicity criteria. Results 43 patients were included in this study. 25 were submitted to RT, in daily fractions of 1.8Gy. The total inguinal-pelvic dose was 45Gy, up to 50.4Gy-66Gy to gross disease. 19 patients were treated with conformal RT and 3 with intensity modulated radiation therapy (IMRT). Two patients were treated in an external facility, two did not completed RT and three had insufficient information. Of the 18 available data, 16% had G3 acute radiodermatitis. No G4 or G5 were reported. No G3 or worse late symptoms were reported. Conclusions The multimodality strategy for advanced CV was feasible and efficient.