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VAN DER ZEE, Ate G. J; OONK, Maaike H; VAN DER VELDEN, Jacobus; HERMANS, Ralph H; VAN DER PUTTEN, Hans; DROUIN, Pierre; SCHNEIDER, Achim; SLUITER, Wim J; DE HULLU, Joanne A; ANSINK, Anca C; VERGOTE, Ignace; VERHEIJEN, René H; MAGGIONI, Angelo; GAARENSTROOM, Katja N; BALDWIN, Peter J; VAN DORST, Eleonore B
Journal of clinical oncology, 02/2008, Letnik: 26, Številka: 6Journal Article
To investigate the safety and clinical utility of the sentinel node procedure in early-stage vulvar cancer patients. A multicenter observational study on sentinel node detection using radioactive tracer and blue dye was performed in patients with T1/2 (< 4 cm) squamous cell cancer of the vulva. When the sentinel node was found to be negative at pathologic ultrastaging, inguinofemoral lymphadenectomy was omitted, and the patient was observed with follow-up for 2 years at intervals of every 2 months. Stopping rules were defined for the occurrence of groin recurrences. From March 2000 until June 2006, a sentinel node procedure was performed in 623 groins of 403 assessable patients. In 259 patients with unifocal vulvar disease and a negative sentinel node (median follow-up time, 35 months), six groin recurrences were diagnosed (2.3%; 95% CI, 0.6% to 5%), and 3-year survival rate was 97% (95% CI, 91% to 99%). Short-term morbidity was decreased in patients after sentinel node dissection only when compared with patients with a positive sentinel node who underwent inguinofemoral lymphadenectomy (wound breakdown in groin: 11.7% v 34.0%, respectively; P < .0001; and cellulitis: 4.5% v 21.3%, respectively; P < .0001). Long-term morbidity also was less frequently observed after removal of only the sentinel node compared with sentinel node removal and inguinofemoral lymphadenectomy (recurrent erysipelas: 0.4% v 16.2%, respectively; P < .0001; and lymphedema of the legs: 1.9% v 25.2%, respectively; P < .0001). In early-stage vulvar cancer patients with a negative sentinel node, the groin recurrence rate is low, survival is excellent, and treatment-related morbidity is minimal. We suggest that sentinel node dissection, performed by a quality-controlled multidisciplinary team, should be part of the standard treatment in selected patients with early-stage vulvar cancer.
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in: SICRIS
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