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Erschienen in: Der Gynäkologe 10/2015

01.10.2015 | CME

Lymphonodektomie beim Vulvakarzinom

verfasst von: PD Dr. Linn Wölber, Sven Mahner, Donata Grimm, Fabian Trillsch, Katharina Prieske

Erschienen in: Die Gynäkologie | Ausgabe 10/2015

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Zusammenfassung

Trotz steigender Inzidenz, von zurzeit 4–6/100.000 Frauen jährlich, gilt das Vulvakarzinom weiterhin als seltene Erkrankung. Der zentrale Prognosefaktor für das krankheitsfreie und das Gesamtüberleben ist der inguinale Lymphknotenstatus. Daher kommt dem operativen Staging der Leisten auch bei klinisch nodal-negativen Tumoren neben der adäquaten lokalen Exzision des Tumors eine besondere Bedeutung zu. Seit Veröffentlichung der Ergebnisse der GROINSS-V(Groningen International Study on Sentinel nodes in Vulvar cancer)-I Studie 2008 gilt die Sentinellymphonodektomie als onkologisch sicher und sollte unter gegebenen Voraussetzungen (unifokaler Primärtumor, Tumorgröße < 4 cm, klinisch unauffällige Leisten) jeder Patientin angeboten werden. Mit der Sentinellymphonodektomie kann die Morbidität bei gleichbleibender onkologischer Sicherheit deutlich reduziert werden. Dieser Review konzentriert sich auf die Indikationsstellung zur Sentinel- vs. kompletten inguinofemoralen Lymphonodektomie bei der nodal-negativen und bei der nodal-positiven Patientin, erörtert das Vorgehen hinsichtlich der pelvinen Lymphknoten und gibt einen Überblick über die aktuelle Studienlage zur Therapie des Vulvakarzinoms.
Literatur
1.
Zurück zum Zitat Judson PL, Habermann EB, Baxter NN et al (2006) Trends in the incidence of invasive and in situ vulvar carcinoma. Obstet Gynecol 107:1018–1022CrossRefPubMed Judson PL, Habermann EB, Baxter NN et al (2006) Trends in the incidence of invasive and in situ vulvar carcinoma. Obstet Gynecol 107:1018–1022CrossRefPubMed
2.
Zurück zum Zitat Smith JS, Backes DM, Hoots BE et al (2009) Human papillomavirus type-distribution in vulvar and vaginal cancers and their associated precursors. Obstet Gynecol 113:917–924CrossRefPubMed Smith JS, Backes DM, Hoots BE et al (2009) Human papillomavirus type-distribution in vulvar and vaginal cancers and their associated precursors. Obstet Gynecol 113:917–924CrossRefPubMed
3.
Zurück zum Zitat Mahner S, Jueckstock J, Hilpert F et al (2015) Adjuvant Therapy in Lymph Node-Positive Vulvar Cancer: The AGO-CaRE-1 Study. J Natl Cancer Inst 107(3) Mahner S, Jueckstock J, Hilpert F et al (2015) Adjuvant Therapy in Lymph Node-Positive Vulvar Cancer: The AGO-CaRE-1 Study. J Natl Cancer Inst 107(3)
4.
Zurück zum Zitat Way S (1948) The anatomy of the lymphatic drainage of the vulva and its influence on the radical operation for carcinoma. Ann R Coll Surg Engl 3:187–209PubMedCentralPubMed Way S (1948) The anatomy of the lymphatic drainage of the vulva and its influence on the radical operation for carcinoma. Ann R Coll Surg Engl 3:187–209PubMedCentralPubMed
5.
Zurück zum Zitat Byron S, Lamb E, Yonemoto R, Kase S (1962) Radical inguinal node dissection int the treatment of cancer. Surg Gynecol Obstet 114:401–408 Byron S, Lamb E, Yonemoto R, Kase S (1962) Radical inguinal node dissection int the treatment of cancer. Surg Gynecol Obstet 114:401–408
6.
Zurück zum Zitat Heaps JM, Fu YS, Montz FJ et al (1990) Surgical-pathologic variables predictive of local recurrence in squamous cell carcinoma of the vulva. Gynecol Oncol 38:309–314CrossRefPubMed Heaps JM, Fu YS, Montz FJ et al (1990) Surgical-pathologic variables predictive of local recurrence in squamous cell carcinoma of the vulva. Gynecol Oncol 38:309–314CrossRefPubMed
7.
Zurück zum Zitat Lin JY, Dubeshter B, Angel C et al (1992) Morbidity and recurrence with modifications of radical vulvectomy and groin dissection. Gynecol Oncol 47:80–86CrossRefPubMed Lin JY, Dubeshter B, Angel C et al (1992) Morbidity and recurrence with modifications of radical vulvectomy and groin dissection. Gynecol Oncol 47:80–86CrossRefPubMed
8.
Zurück zum Zitat Mahner S, Prieske K, Grimm D et al (2015) Systemic treatment of vulvar cancer. Expert Rev Anticancer Ther 15:629–637CrossRefPubMed Mahner S, Prieske K, Grimm D et al (2015) Systemic treatment of vulvar cancer. Expert Rev Anticancer Ther 15:629–637CrossRefPubMed
9.
Zurück zum Zitat Hampl M, Kueppers V, Bender HG (2009) Single large inguinal lymph node metastasis in human papillomavirus-induced early invasive vulvar cancer of the anterior fourchette in two young women. Gynecol Obstet Invest 67:42–45 Hampl M, Kueppers V, Bender HG (2009) Single large inguinal lymph node metastasis in human papillomavirus-induced early invasive vulvar cancer of the anterior fourchette in two young women. Gynecol Obstet Invest 67:42–45
10.
Zurück zum Zitat Iversen T, Abeler V, Aalders J (1981) Individualized treatment of stage I carcinoma of the vulva. Obstet Gynecol 57:85–89PubMed Iversen T, Abeler V, Aalders J (1981) Individualized treatment of stage I carcinoma of the vulva. Obstet Gynecol 57:85–89PubMed
11.
Zurück zum Zitat National German Guideline S2k (2015) Diagnosis, Therapy, and Follow-Up Care of Vulvar Cancer and its Precursors, AWMF Registry No. 015/059 National German Guideline S2k (2015) Diagnosis, Therapy, and Follow-Up Care of Vulvar Cancer and its Precursors, AWMF Registry No. 015/059
12.
Zurück zum Zitat De Gregorio N, Ebner F, Schwentner L et al (2013) The role of preoperative ultrasound evaluation of inguinal lymph nodes in patients with vulvar malignancy. Gynecol Oncol 131:113–117CrossRefPubMed De Gregorio N, Ebner F, Schwentner L et al (2013) The role of preoperative ultrasound evaluation of inguinal lymph nodes in patients with vulvar malignancy. Gynecol Oncol 131:113–117CrossRefPubMed
13.
Zurück zum Zitat Homesley HD, Bundy BN, Sedlis A et al (1993) Prognostic factors for groin node metastasis in squamous cell carcinoma of the vulva (a Gynecologic Oncology Group study). Gynecol Oncol 49:279–283CrossRefPubMed Homesley HD, Bundy BN, Sedlis A et al (1993) Prognostic factors for groin node metastasis in squamous cell carcinoma of the vulva (a Gynecologic Oncology Group study). Gynecol Oncol 49:279–283CrossRefPubMed
14.
Zurück zum Zitat Woelber L, Mahner S, Voelker K et al (2009) Clinicopathological prognostic factors and patterns of recurrence in vulvar cancer. Anticancer Res 29:545–552PubMed Woelber L, Mahner S, Voelker K et al (2009) Clinicopathological prognostic factors and patterns of recurrence in vulvar cancer. Anticancer Res 29:545–552PubMed
15.
Zurück zum Zitat Hinten F, Van Den Einden LC, Hendriks JC et al (2011) Risk factors for short- and long-term complications after groin surgery in vulvar cancer. Br J Cancer 105:1279–1287PubMedCentralCrossRefPubMed Hinten F, Van Den Einden LC, Hendriks JC et al (2011) Risk factors for short- and long-term complications after groin surgery in vulvar cancer. Br J Cancer 105:1279–1287PubMedCentralCrossRefPubMed
16.
Zurück zum Zitat Levenback C, Burke TW, Gershenson DM et al (1994) Intraoperative lymphatic mapping for vulvar cancer. Obstet Gynecol 84:163–167PubMed Levenback C, Burke TW, Gershenson DM et al (1994) Intraoperative lymphatic mapping for vulvar cancer. Obstet Gynecol 84:163–167PubMed
17.
Zurück zum Zitat de Hullu JA, Doting E, Piers DA et al (1998) Sentinel lymph node identification with technetium-99m-labeled nanocolloid in squamous cell cancer of the vulva. J Nucl Med 39:1381–1385 (official publication, Society of Nuclear Medicine)PubMed de Hullu JA, Doting E, Piers DA et al (1998) Sentinel lymph node identification with technetium-99m-labeled nanocolloid in squamous cell cancer of the vulva. J Nucl Med 39:1381–1385 (official publication, Society of Nuclear Medicine)PubMed
18.
Zurück zum Zitat Hassanzade M, Attaran M, Treglia G et al (2013) Lymphatic mapping and sentinel node biopsy in squamous cell carcinoma of the vulva: systematic review and meta-analysis of the literature. Gynecol Oncol 130:237–245CrossRefPubMed Hassanzade M, Attaran M, Treglia G et al (2013) Lymphatic mapping and sentinel node biopsy in squamous cell carcinoma of the vulva: systematic review and meta-analysis of the literature. Gynecol Oncol 130:237–245CrossRefPubMed
19.
Zurück zum Zitat Van der Zee AG, Oonk MH, de Hullu JA et al (2008) Sentinel node dissection is safe in the treatment of early-stage vulvar cancer. J Clin Oncol 26:884–889 (official journal of the American Society of Clinical Oncology)CrossRefPubMed Van der Zee AG, Oonk MH, de Hullu JA et al (2008) Sentinel node dissection is safe in the treatment of early-stage vulvar cancer. J Clin Oncol 26:884–889 (official journal of the American Society of Clinical Oncology)CrossRefPubMed
20.
Zurück zum Zitat Burke TW, Levenback C, Coleman RL et al (1995) Surgical therapy of T1 and T2 vulvar carcinoma: further experience with radical wide excision and selective inguinal lymphadenectomy. Gynecol Oncol 57:215–220CrossRefPubMed Burke TW, Levenback C, Coleman RL et al (1995) Surgical therapy of T1 and T2 vulvar carcinoma: further experience with radical wide excision and selective inguinal lymphadenectomy. Gynecol Oncol 57:215–220CrossRefPubMed
21.
Zurück zum Zitat Katz A, Eifel PJ, Jhingran A et al (2003) The role of radiation therapy in preventing regional recurrences of invasive squamous cell carcinoma of the vulva. Int J Radiat Oncol Biol Phys 57:409–418CrossRefPubMed Katz A, Eifel PJ, Jhingran A et al (2003) The role of radiation therapy in preventing regional recurrences of invasive squamous cell carcinoma of the vulva. Int J Radiat Oncol Biol Phys 57:409–418CrossRefPubMed
22.
Zurück zum Zitat Hampl M, Hantschmann P, Michels W et al (2008) Validation of the accuracy of the sentinel lymph node procedure in patients with vulvar cancer: results of a multicenter study in Germany. Gynecol Oncol 111:282–288CrossRefPubMed Hampl M, Hantschmann P, Michels W et al (2008) Validation of the accuracy of the sentinel lymph node procedure in patients with vulvar cancer: results of a multicenter study in Germany. Gynecol Oncol 111:282–288CrossRefPubMed
23.
Zurück zum Zitat Levenback CF, Ali S, Coleman RL et al (2012) Lymphatic mapping and sentinel lymph node biopsy in women with squamous cell carcinoma of the vulva: a gynecologic oncology group study. Clin Oncol 30:3786–3791 (official journal of the American Society of Clinical Oncology)CrossRef Levenback CF, Ali S, Coleman RL et al (2012) Lymphatic mapping and sentinel lymph node biopsy in women with squamous cell carcinoma of the vulva: a gynecologic oncology group study. Clin Oncol 30:3786–3791 (official journal of the American Society of Clinical Oncology)CrossRef
24.
Zurück zum Zitat Woelber L, Grimm D, Vettorazzi E et al (2013) Secondary sentinel node biopsy after previous excision of the primary tumor in squamous cell carcinoma of the vulva. Ann Surg Oncol 20:1701–1706CrossRefPubMed Woelber L, Grimm D, Vettorazzi E et al (2013) Secondary sentinel node biopsy after previous excision of the primary tumor in squamous cell carcinoma of the vulva. Ann Surg Oncol 20:1701–1706CrossRefPubMed
25.
Zurück zum Zitat Gordinier ME, Malpica A, Burke TW et al (2003) Groin recurrence in patients with vulvar cancer with negative nodes on superficial inguinal lymphadenectomy. Gynecol Oncol 90:625–628CrossRefPubMed Gordinier ME, Malpica A, Burke TW et al (2003) Groin recurrence in patients with vulvar cancer with negative nodes on superficial inguinal lymphadenectomy. Gynecol Oncol 90:625–628CrossRefPubMed
26.
Zurück zum Zitat Podratz KC, Symmonds RE, Taylor WF (1982) Carcinoma of the vulva: analysis of treatment failures. Am J Obstet Gynecol 143:340–351PubMed Podratz KC, Symmonds RE, Taylor WF (1982) Carcinoma of the vulva: analysis of treatment failures. Am J Obstet Gynecol 143:340–351PubMed
27.
Zurück zum Zitat Courtney-Brooks M, Sukumvanich P, Beriwal S et al (2010) Does the number of nodes removed impact survival in vulvar cancer patients with node-negative disease. Gynecol Oncol 117:308–311CrossRefPubMed Courtney-Brooks M, Sukumvanich P, Beriwal S et al (2010) Does the number of nodes removed impact survival in vulvar cancer patients with node-negative disease. Gynecol Oncol 117:308–311CrossRefPubMed
28.
Zurück zum Zitat Van Der Velden K, Ansink A (2001) Primary groin irradiation vs primary groin surgery for early vulvar cancer. Cochrane Database Syst Rev (4):CD002224 Van Der Velden K, Ansink A (2001) Primary groin irradiation vs primary groin surgery for early vulvar cancer. Cochrane Database Syst Rev (4):CD002224
29.
Zurück zum Zitat Stehman FB, Bundy BN, Thomas G et al (1992) Groin dissection versus groin radiation in carcinoma of the vulva: a Gynecologic Oncology Group study. Int J Radiat Oncol Biol Phys 24:389–396CrossRefPubMed Stehman FB, Bundy BN, Thomas G et al (1992) Groin dissection versus groin radiation in carcinoma of the vulva: a Gynecologic Oncology Group study. Int J Radiat Oncol Biol Phys 24:389–396CrossRefPubMed
30.
Zurück zum Zitat Oonk Mh MH, van Hemel Bm BM, Hollema H et al (2010) Size of sentinel-node metastasis and chances of non-sentinel-node involvement and survival in early stage vulvar cancer: results from GROINSS-V, a multicentre observational study. Lancet Oncol 11:646–652CrossRefPubMed Oonk Mh MH, van Hemel Bm BM, Hollema H et al (2010) Size of sentinel-node metastasis and chances of non-sentinel-node involvement and survival in early stage vulvar cancer: results from GROINSS-V, a multicentre observational study. Lancet Oncol 11:646–652CrossRefPubMed
31.
Zurück zum Zitat Oonk MH, De Hullu JA, van der Zee AG (2010) Current controversies in the management of patients with early-stage vulvar cancer. Curr Opin Oncol 22:481–486CrossRefPubMed Oonk MH, De Hullu JA, van der Zee AG (2010) Current controversies in the management of patients with early-stage vulvar cancer. Curr Opin Oncol 22:481–486CrossRefPubMed
32.
Zurück zum Zitat Oonk MH, van de Nieuwenhof HP, De Hullu JA et al (2009) The role of sentinel node biopsy in gynecological cancer: a review. Curr Opin Oncol 21:425–432CrossRefPubMed Oonk MH, van de Nieuwenhof HP, De Hullu JA et al (2009) The role of sentinel node biopsy in gynecological cancer: a review. Curr Opin Oncol 21:425–432CrossRefPubMed
33.
Zurück zum Zitat Andrews SJ, Williams BT, Depriest PD et al (1994) Therapeutic implications of lymph nodal spread in lateral T1 and T2 squamous cell carcinoma of the vulva. Gynecol Oncol 55:41–46CrossRefPubMed Andrews SJ, Williams BT, Depriest PD et al (1994) Therapeutic implications of lymph nodal spread in lateral T1 and T2 squamous cell carcinoma of the vulva. Gynecol Oncol 55:41–46CrossRefPubMed
34.
Zurück zum Zitat Stehman FB, Bundy BN, Dvoretsky PM et al (1992) Early stage I carcinoma of the vulva treated with ipsilateral superficial inguinal lymphadenectomy and modified radical hemivulvectomy: a prospective study of the Gynecologic Oncology Group. Obstet Gynecol 79:490–497PubMed Stehman FB, Bundy BN, Dvoretsky PM et al (1992) Early stage I carcinoma of the vulva treated with ipsilateral superficial inguinal lymphadenectomy and modified radical hemivulvectomy: a prospective study of the Gynecologic Oncology Group. Obstet Gynecol 79:490–497PubMed
35.
Zurück zum Zitat Gonzalez Bosquet J, Magrina JF, Magtibay PM et al (2007) Patterns of inguinal groin metastases in squamous cell carcinoma of the vulva. Gynecol Oncol 105:742–746CrossRefPubMed Gonzalez Bosquet J, Magrina JF, Magtibay PM et al (2007) Patterns of inguinal groin metastases in squamous cell carcinoma of the vulva. Gynecol Oncol 105:742–746CrossRefPubMed
36.
Zurück zum Zitat Woelber L, Eulenburg C, Grimm D et al (2015) The risk of contralateral non sentinel metastasis in patients with primary vulvar cancer and unilaterally positive sentinel node. manuscript submitted 08/2015 Woelber L, Eulenburg C, Grimm D et al (2015) The risk of contralateral non sentinel metastasis in patients with primary vulvar cancer and unilaterally positive sentinel node. manuscript submitted 08/2015
37.
Zurück zum Zitat Boyce J, Fruchter RG, Kasambilides E et al (1985) Prognostic factors in carcinoma of the vulva. Gynecol Oncol 20:364–377CrossRefPubMed Boyce J, Fruchter RG, Kasambilides E et al (1985) Prognostic factors in carcinoma of the vulva. Gynecol Oncol 20:364–377CrossRefPubMed
38.
Zurück zum Zitat Hacker NF, van der Velden J (1993) Conservative management of early vulvar cancer. Cancer 71:1673–1677CrossRefPubMed Hacker NF, van der Velden J (1993) Conservative management of early vulvar cancer. Cancer 71:1673–1677CrossRefPubMed
39.
Zurück zum Zitat Klemm P, Marnitz S, Kohler C et al (2005) Clinical implication of laparoscopic pelvic lymphadenectomy in patients with vulvar cancer and positive groin nodes. Gynecol Oncol 99:101–105CrossRefPubMed Klemm P, Marnitz S, Kohler C et al (2005) Clinical implication of laparoscopic pelvic lymphadenectomy in patients with vulvar cancer and positive groin nodes. Gynecol Oncol 99:101–105CrossRefPubMed
40.
Zurück zum Zitat van der Velden J, van Lindert AC, Lammes FB et al (1995) Extracapsular growth of lymph node metastases in squamous cell carcinoma of the vulva. The impact on recurrence and survival. Cancer 75:2885–2890CrossRefPubMed van der Velden J, van Lindert AC, Lammes FB et al (1995) Extracapsular growth of lymph node metastases in squamous cell carcinoma of the vulva. The impact on recurrence and survival. Cancer 75:2885–2890CrossRefPubMed
41.
Zurück zum Zitat Homesley HD, Bundy BN, Sedlis A et al (1986) Radiation therapy versus pelvic node resection for carcinoma of the vulva with positive groin nodes. Obstet Gynecol 68:733–740PubMed Homesley HD, Bundy BN, Sedlis A et al (1986) Radiation therapy versus pelvic node resection for carcinoma of the vulva with positive groin nodes. Obstet Gynecol 68:733–740PubMed
42.
Zurück zum Zitat Curry SL, Wharton JT, Rutledge F (1980) Positive lymph nodes in vulvar squamous carcinoma. Gynecol Oncol 9:63–67CrossRefPubMed Curry SL, Wharton JT, Rutledge F (1980) Positive lymph nodes in vulvar squamous carcinoma. Gynecol Oncol 9:63–67CrossRefPubMed
43.
Zurück zum Zitat Hacker JF, Berek JS, Lagasse LD et al (1983) Management of regional lymph nodes and their prognostic influence in vulvar cancer. Obstet Gynecol 61:408–412PubMed Hacker JF, Berek JS, Lagasse LD et al (1983) Management of regional lymph nodes and their prognostic influence in vulvar cancer. Obstet Gynecol 61:408–412PubMed
44.
Zurück zum Zitat Thaker Ng, Klopp Ah, Jhingran A et al (2015) Survival outcomes for patients with stage IVB vulvar cancer with grossly positive pelvic lymph nodes: time to reconsider the FIGO staging system? Gynecol Oncol 136:269–273CrossRefPubMed Thaker Ng, Klopp Ah, Jhingran A et al (2015) Survival outcomes for patients with stage IVB vulvar cancer with grossly positive pelvic lymph nodes: time to reconsider the FIGO staging system? Gynecol Oncol 136:269–273CrossRefPubMed
Metadaten
Titel
Lymphonodektomie beim Vulvakarzinom
verfasst von
PD Dr. Linn Wölber
Sven Mahner
Donata Grimm
Fabian Trillsch
Katharina Prieske
Publikationsdatum
01.10.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Die Gynäkologie / Ausgabe 10/2015
Print ISSN: 2731-7102
Elektronische ISSN: 2731-7110
DOI
https://doi.org/10.1007/s00129-015-3775-z

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