Division of Gynecologic Oncology, University of Toronto, M700-610 University Avenue, Toronto, ON M5N 2L5, Canada.
Division of Gynecologic Oncology, University of Toronto, M700-610 University Avenue, Toronto, ON M5N 2L5, Canada; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Juravinski Cancer Centre, McMaster University, 699 Concession St, Hamilton, ON L8V 5C2, Canada.
Gynecol Oncol. 2014 Mar;132(3):780-9. doi: 10.1016/j.ygyno.2013.11.025. Epub 2013 Dec 1.
The advances achieved in the surgical management of vulvar squamous cell carcinoma (SCC) have not been mirrored in systemic therapy options. The objective of this paper is to summarize current evidence regarding systemic therapy in vulvar cancer, review the latest research on the biology of this disease, and identify future strategies to improve patient management.
MEDLINE and EMBASE were searched for all relevant English-language articles from inception to December 10, 2012. Existing evidence regarding systemic therapy in vulvar SCC was synthesized descriptively, with an emphasis on prospective studies when available. Single-patient case-reports were excluded.
We identified 12 studies of neoadjuvant chemoradiation, 8 studies of neoadjuvant chemotherapy alone, 18 studies of chemoradiation as primary therapy, 4 studies of chemotherapy in the adjuvant setting, and 8 studies of chemotherapy for recurrent or metastatic disease. Review of the biology of vulvar cancer was performed, and promising targets for the future were identified based on the two biologic pathways of disease development. New therapeutic strategies such as immune-therapy and targeted agents hold promise for the future.
Advances in systemic therapy for vulvar SCC are urgently needed, especially in the setting of recurrent and metastatic disease. A focus on the investigation of new targeted agents is encouraged and consideration of quality of life and sexual health issues is essential. International cooperation and adaptive trial designs are required to improve outcomes for this group of traditionally under-served women.
外阴鳞状细胞癌（SCC）的外科治疗进展并未反映在系统治疗选择中。本文旨在总结外阴癌系统治疗的现有证据，回顾该疾病生物学的最新研究，并确定改善患者管理的未来策略。
从 MEDLINE 和 EMBASE 搜索了截至 2012 年 12 月 10 日所有相关的英文文献。对外阴 SCC 的系统治疗进行了描述性综合，重点关注现有前瞻性研究。排除了单一患者病例报告。
我们确定了 12 项新辅助放化疗研究、8 项新辅助化疗研究、18 项单纯放化疗作为主要治疗方法、4 项辅助化疗研究和 8 项复发或转移性疾病化疗研究。对外阴癌的生物学进行了回顾，根据疾病发展的两种生物学途径确定了未来有前途的靶点。新的治疗策略，如免疫治疗和靶向药物，为未来带来了希望。
迫切需要在外阴 SCC 的系统治疗方面取得进展，尤其是在复发性和转移性疾病的情况下。鼓励重点研究新的靶向药物，并考虑生活质量和性健康问题。需要国际合作和适应性试验设计，以改善这组传统上服务不足的女性的预后。
