[Treatment of vulvar cancer--updated information]

Abstract

Over the past 20 years, the management of vulvar cancer has changed dramatically. The radical vulvectomy that was previously believed to be the only effective treatment for vulvar cancer has now been replaced by more individualized treatments. These include conservative surgery for patients with isolated lesions, omission of groin lymph node dissection in T1A tumors with stromal invasion < 1 mm, elimination of routine pelvic lymphadenectomy, groin lymph node dissection with separate groin incision, omission of contralateral groin lymph node dissection in T1 tumor with negative ipsilateral node metastasis, use of preoperative radiotherapy to avoid pelvic exenteration in advanced cases, and postoperative radiotherapy to decrease the incidence of groin recurrence in patients with multiple positive groin nodes. In addition to these changes, the identification of sentinel lymph nodes and chemoradiation therapy are currently under investigation. In this review, we discuss these issues along with the evidence upon which these therapies are based.