The role of radiation therapy in preventing regional recurrences of invasive squamous cell carcinoma of the vulva

Purpose: To evaluate treatment of the inguinal nodes for patients with squamous cell carcinoma of the vulva. Methods and Materials: We reviewed the records of 227 patients who had treatment of the inguinal lymph nodes between 1980 and 1998 for squamous cell carcinoma of the vulva. The inguinal nodes were clinically suspicious in 67 patients and clinically negative in 160. Regional treatment was as follows: lymph node dissection (LND) alone in 119 patients, LND plus radiation therapy (RT) in 57, and RT alone in 51. The extent of LND ranged from node excision to radical inguinal LND; all patients treated with LND alone had at least a superficial inguinal LND. Median follow-up of surviving patients was 98 months. Rates of inguinal node recurrence (INR) at 5 years were calculated using the Kaplan-Meier method. Results: Thirty-two patients had INRs (5-year INR rate, 15.4%). Patients who received RT alone or RT + LND were significantly more likely than those treated with LND alone to have T3-4 tumors, tumors >5 cm, or lymph node involvement. However, 5-year INR rates were similar for the three groups (16%, 13%, and 16%, respectively). For patients who had LND only, the risk of INR was greater if the primary tumor was more than 2 cm (p = 0.056) or poorly differentiated (p = 0.04). For patients who had postoperative RT, INR was significantly greater if the time from LND to RT was greater than 50 days (p = 0.03). Ten patients had severe groin or lower-extremity complications after LND. Two patients died of postoperative cardiopulmonary complications. Six patients who were treated with RT had hip fractures or hip replacements after treatment. Conclusion: RT alone or in combination with LND is highly effective in preventing INR in patients with squamous cell carcinoma of the vulva and is associated with a low risk of major late complications.