Department of Gynaecology and Gynaecologic Oncology, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
Ther Adv Med Oncol. 2013 May;5(3):183-92. doi: 10.1177/1758834012471699.
Treatment of patients with vulvar cancer is challenging for gynaecologic oncologists. Owing to the localization in a sensitive area, surgical radicality and the indication for adjuvant treatment have to be balanced with psychosocial aspects to treat patients adequately. Clinical management is therefore highly dependent on the tumour stage. For patients with early-stage disease (FIGO I-II) therapy mainly concentrates on surgery with resection of the primary tumour and staging of the groin lymph nodes. In intermediate-stage vulvar cancer (FIGO III), advanced disease is expressed by affected inguinofemoral lymph nodes bringing radical lymphadenectomy and adjuvant therapy as well as radiation or chemoradiation into the focus of treatment. For locally advanced or metastatic vulvar cancer (FIGO IV) neoadjuvant or definitive chemoradiation has to be considered besides surgery. Owing to the low incidence of the disease, the level of evidence for different treatment modalities is poor. This review therefore puts different recommendations of clinical management in context and highlights the need for future trials.
外阴癌患者的治疗对妇科肿瘤医生来说具有挑战性。由于病变部位位于敏感区域，因此手术的根治性和辅助治疗的适应证必须与社会心理因素相平衡，从而充分治疗患者。临床管理因此高度依赖于肿瘤分期。对于早期疾病（FIGO I-II 期）的患者，治疗主要集中在手术上，包括切除原发肿瘤和进行腹股沟淋巴结分期。对于中期外阴癌（FIGO III 期），晚期疾病表现为腹股沟股淋巴结受累，需要进行根治性淋巴结切除术和辅助治疗以及放疗或放化疗。对于局部晚期或转移性外阴癌（FIGO IV 期），除手术外还需要考虑新辅助或根治性放化疗。由于该疾病的发病率较低，不同治疗方式的证据水平较差。因此，本文将不同的临床管理建议置于上下文中，并强调了未来试验的必要性。
