Neoadjuvant chemotherapy in advanced vulvar cancer.

ABSTRACT

INTRODUCTION: Locally advanced tumors of the vulva represent approximately one third of all vulvar cancers. Therapeutic options include chemoradiation, radiotherapy, and neoadjuvant chemotherapy (NACT). MATERIALS AND METHODS: Analysis of 3 NACT schemes, bleomicine, paclitaxel, and 5-fluorouracil/cisplatin, used in patients with locally advanced vulvar tumors in a 12-year period. The following parameters were evaluated and compared between regimens age, initial tumor size, inguinal involvement, histological type, toxicities, response to treatment, surgery performed after NACT, and overall survival. RESULTS: Of the 25 patients included, 10 underwent an NACT regimen with bleomicine (Group A); 5, with paclitaxel (Group B); and 10, with a combination of 5-fluorouracil/cisplatin (Group C). In Group A, there was a 60% response rate. Mortality was 70%, with an overall survival rate of 70%, 40%, and 30% at 12, 24, and 60 months, respectively. The mean (SD) survival was 46.7 (15.4) months. In Group B, the response rate was 40%, with an 80% mortality rate and a survival rate of 60% and 20% at 12 and 24 months, respectively. The mean (SD) survival was 17.0 (3.8) months. In Group C, 20% of the responses were observed and the mortality was 90%, with an overall survival rate of 10% at 12 and 24 months and a mean (SD) survival of 7.6 (2.0) months. CONCLUSION: The best response and overall survival rates were achieved in Group A with the NACT scheme of bleomicine.