Dr Nasioudis on the Use of SLNB in Metastatic Vulvar Squamous Cell Carcinoma

Dimitrios Nasioudis, MD, fellow, Gynecologic Oncology, Perelman School of Medicine, the University of Pennsylvania, discusses findings from a study investigating outcomes of real-world patients with early-stage, metastatic vulvar squamous cell carcinoma who underwent sentinel lymph node biopsy (SLNB).

For patients with negative nodes per SLNB, the long-term outlook was promising, with a 5.2% to 7% incidence of groinal recurrence, even in the absence of additional treatment, Nasioudis begins. Conversely, patients with micrometastases faced a considerably heightened risk of groinal and/or distant disease recurrence, particularly if they opted out of receiving adjuvant treatment, with approximately 40% of these patients experiencing such recurrence, he states. This finding underscores the importance of intervention in this cohort to mitigate the risk of disease progression, Nasioudis adds.

Moreover, there exists a discernible variability in the approaches to treating patients with micrometastases, he expands. Some health care providers opt for external beam radiation therapy alone, others advocate for a combination of external beam radiation therapy and inguinal femoral lymphadenectomy, and others recommend inguinal femoral lymphadenectomy as a standalone procedure, Nasioudis explains. This disparity underscores the inconsistency and lack of standardized guidelines in the treatment practices for this patient population, he says.

The ongoing phase 3 GROINSS-VIII study is investigating whether inguinal femoral lymphadenectomy can be safely omitted in the treatment of these patients and whether chemoradiation presents a viable treatment alternative, Nasioudis continues. The results of this study will provide valuable insights into optimizing treatment strategies for patients with micrometastases, potentially streamlining care and improving outcomes, he elucidates, adding that patients who undergo radiosensitized chemotherapy exhibit a trend toward lower recurrence rates. This observation raises intriguing possibilities for improving treatment efficacy in this population, according to Nasioudis.

Given these findings, Nasioudis says investigators are eager to delve deeper into the dataset to conduct a more comprehensive analysis and confirm the potential benefits of radiosensitized chemotherapy. This further exploration may yield valuable insights into refining treatment protocols and ultimately enhancing patient outcomes in this challenging clinical scenario, he concludes.

Disclosures: Dr Nasioudis reports no financial relationships.