多学科个性化方法在外阴癌管理中的应用——Vul.Can 团队的经验。

Multidisciplinary personalized approach in the management of vulvar cancer - the Vul.Can Team experience.

机构信息

Unità Operativa Complessa di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Lazio, Italy.

Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Lazio, Italy.

出版信息

Int J Gynecol Cancer. 2020 Jul;30(7):932-938. doi: 10.1136/ijgc-2020-001465. Epub 2020 May 30.

DOI:10.1136/ijgc-2020-001465

PMID:32474446

Abstract

INTRODUCTION

Multidisciplinary treatment strategy involving adjuvant radiotherapy for advanced vulvar cancer could be useful in offering the best personalized clinical approach. In 2013, the VULvar CANcer Multi-Disciplinary Team (Vul.Can MDT) was set up in our institution, in order to share knowledge and expertise, high-quality diagnosis, and evidence-based decision making in the context of personalized medicine. The aim of this observational study was to report on our series of vulvar cancer patients managed postoperatively with radiotherapy within the framework of a formal multidisciplinary tumor board.

METHODS

Coupling surgical and oncological international guidelines with "case-by-case" discussions, a multi-specialist consensus was progressively reached and internal recommendations were developed and introduced in the daily routine. Data from vulvar cancer patients who underwent primary surgery and adjuvant radiotherapy throughout a 5-year period were retrospectively collected. Actuarial local control was the primary endpoint, while secondary end-points were acute and late toxicities, disease-free survival, and overall survival. Toxicity was evaluated according to the Common Toxicity Criteria Adverse Event v 4.0 scale.

RESULTS

The analysis included 35 patients with squamous vulvar cancer treated with adjuvant radiotherapy±chemotherapy, from April 2013 to September 2017. Median age was 70 years (range 18-87), all patients underwent surgery followed by concomitant chemoradiation (45.7%) or radiotherapy alone (54.3%). The median prophylactic dose on lymphatic drainage was 45 Gy, while positive nodes and perineal area received 51.2 Gy and 52.6 Gy, respectively. Chemotherapy involved the cisplatin-based regimen (45.7%)±5-fluorouracil (37.1%). Median follow-up was 32 months (range 6-72): the 24-months local control, disease-free survival, and actuarial overall survival rates were 88.6%, 82.0%, and 91.0%, respectively. Low rates of severe acute (12%) and late (3%) toxicities occurred.

DISCUSSION

The outcomes of this series support the benefit of a multidisciplinary personalized approach in the management of vulvar cancer.

摘要

简介

对于晚期外阴癌，多学科治疗策略包括辅助放疗，这可能有助于提供最佳的个性化临床方法。2013 年，我们机构成立了外阴癌多学科团队（Vul.Can MDT），以便在个性化医学背景下分享知识和专业技能、提供高质量的诊断和基于证据的决策。本观察性研究的目的是报告我们一系列外阴癌患者在正式多学科肿瘤委员会框架内接受术后放疗的情况。

方法

结合手术和肿瘤学国际指南，并进行“逐个病例”讨论，多学科专家逐渐达成共识，并制定内部建议，引入日常工作中。回顾性收集了 5 年内接受原发性手术和辅助放疗的外阴癌患者的数据。局部控制的累积生存率是主要终点，次要终点是急性和晚期毒性、无病生存率和总生存率。毒性根据通用不良事件毒性标准 4.0 量表进行评估。

结果

分析包括 2013 年 4 月至 2017 年 9 月期间接受辅助放疗±化疗的 35 例鳞状外阴癌患者。中位年龄为 70 岁（范围 18-87 岁），所有患者均接受手术，随后接受同期放化疗（45.7%）或单纯放疗（54.3%）。预防性淋巴引流区域的中位剂量为 45Gy，阳性淋巴结和会阴区的剂量分别为 51.2Gy 和 52.6Gy。化疗方案包括顺铂为基础的方案（45.7%）±5-氟尿嘧啶（37.1%）。中位随访时间为 32 个月（范围 6-72 个月）：24 个月的局部控制、无病生存率和累积总生存率分别为 88.6%、82.0%和 91.0%。急性（12%）和晚期（3%）毒性发生率较低。