Vulva Cancer Studies

Pre-operative chemoradiation

GOG 101 (Moore) (1998) - Phase II study

  • 73 patients stage III-IV SCC vulvar carcinoma


  • Cisplatin/f-FU with radiation to 4760 (median) 170 cGy split-course dosed to mid-plane
  • Surgical excision of the residual primary tumor plus bilateral inguinal-femoral lymph node dissection
  • Patients who are judged to have unresectable disease after completion of 47.6 Gy had additional 20 Gy in 1.7 to 2.0 Gy per fraction to gross residual disease OR they had additional dose through brachytherapy.


  • 55% DFS at 4-years
  • Authors' Conclusion: Preoperative chemoradiotherapy in advanced squamous cell carcinoma of the vulva is feasible, and may reduce the need for more radical surgery including primary pelvic exenteration.

Irradiation of Undissected Groin

GOG 88 (Stehman)

  • reported an 18.5% (5 of 27) incidence of groin recurrence with elective irradiation of regional nodes versus none in 25 patients undergoing bilateral lymph node dissection.
  • Noteworthy, the irradiation dose (50 Gy) was prescribed at 3 cm below the anterior skin surface, and it was recommended that 50% of dose be given with 12 to 13 MeV electrons. This resulted in a significant underdose to the nodes deeper than 4 cm.
  • McCall et al. [49] evaluated the depth of inguinal lymph nodes with computed tomography (CT) scans in 100 women without palpable inguinal adenopathy or prior inguinal surgery. The tumor doses the patients would have received were determined using isodose curves constructed according to the guidelines in GOG protocol No. 88.
  • Only 18% of women had all inguinal lymph nodes measured at a depth of 3 cm or less.
  • More than half of all women would have received less than 60% of the prescribed irradiation dose because their inguinal lymph nodes were deeper than 5 cm.

Post-operative Radiation

GOG 36 (Homesley 1986)

  • 114 eligible patients from 1977 to 1984
  • SCCA of vulva with positive “groin” nodes


  • All patients had radical vulvectomy and bilateral groin lymphadenectomy
    • Inguinal lymphadenectomy included a resection of groin nodes both superficial and deep to the inguinofemoral fascia with skeletonization of the femoral artery an vein
    • Nodal tissue medial to the femoral vein was designated the Cloquet node

Treatment and Results

Groups OS-2 OS-2 for 1 LN+ "Groin" Recurrence Rate
post-op “groin” irradiation 68% 75% 5.1%
ipsilateral pelvic node dissection 54% 75% 23.6%
p-value .03 N.S. .02
  • ipsilateral pelvic node dissection
    • extraperitoneal approach was used to resect the external iliac, internal iliac, obturator, and common iliac nodes.
  • RT technique
    • Start within 6 weeks postoperatively
    • Both groins, obturator, external and internal iliac areas
    • 4500 to 5000 rads to midplane halfway between
    • L5-S1 interspace
    • superior border of the obturator foramin
    • 180 to 200 rads per day.
    • 4.5 to 6 weeks.
    • Dose to a depth of 2 to 3 cm from the anterior surface at the center of the inguinal and femoral node area
    • AP-PA fields were used with each field treated daily
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