BACKGROUND.
Recent advancement in recommended treatment of early stage vulvar carcinoma had emphasized the role of pathologic indications of tumor size and lymph node involvement. The purpose of this study was to identify the current mode of practice in the management of early stage vulvar carcinoma with primary disease limited to the vulva and/or the perineum.
METHODS.
The National Cancer Data Base was accessed to examine vulvar carcinoma cases reported by 1147 hospitals that had established or were establishing American College of Surgeons Commission on Cancer programs. The periods 1988-1989 and 1993-1994 were selected for analysis. The analysis was based on the 1553 invasive nonmetastatic carcinomas (confined to the vulva and/or the perineum) for which primary lesion size and pathologic inguinal lymph node evaluation had been recorded.
RESULTS.
There were no differences in demographic or disease characteristics between 1988-1989 and 1993-1994. Surgery alone was most often the treatment for lymph node negative patients. Radiation therapy was given as an adjunct treatment to 49% of patients with positive lymph nodes. Radiation therapy was given fairly equally to patients in all lymph node positive categories (1, 2-3, and 4 or more positive lymph nodes), with little change between the two time periods. Patients with ยฐ2 cm lesions were more often treated with conservative surgery.
CONCLUSIONS.
The major diagnostic groups and number of positive lymph nodes were confirmed to be prognostically important. Although literature on vulvar disease notes a benefit of radiaton therapy for patients with more than one positive lymph node, radiation therapy was not predictive of survival for patients in this study.