Review

. 2025 Jan 8;17(2):186.

doi: 10.3390/cancers17020186.

Management of Patients with Vulvar Cancers: A Systematic Comparison of International Guidelines (NCCN-ASCO-ESGO-BGCS-IGCS-FIGO-French Guidelines-RCOG)

Stefano Restaino^{1

2}, Giulia Pellecchia^{1

3}, Martina Arcieri¹, Giorgio Bogani⁴, Cristina Taliento⁵, Pantaleo Greco⁵, Lorenza Driul^{1

3}, Vito Chiantera^{6

7}, Rosa Pasqualina De Vincenzo⁸, Giorgia Garganese⁹, Francesco Sopracordevole¹⁰, Violante Di Donato¹¹, Andrea Ciavattini¹², Paolo Scollo¹³, Giovanni Scambia⁸, Giuseppe Vizzielli^{1

3}, Gynecologic Oncology Group

Affiliations

¹ Clinic of Obstetrics and Gynecology, "Santa Maria della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy.
² PhD School in Biomedical Sciences, Gender Medicine, Child and Women Health, University of Sassari, 07100 Sassari, Italy.
³ Department of Medicine, University of Udine, 33100 Udine, Italy.
⁴ Gynaecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy.
⁵ Department of Medical Sciences, Obstetrics and Gynecology Unit, University of Ferrara, 44121 Ferrara, Italy.
⁶ Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy.
⁷ Unit of Gynecologic Oncology, National Cancer Institute, IRCCS, Fondazione "G. Pascale", 80131 Naples, Italy.
⁸ Department of Women's, Child and Public Health Sciences, UOC Gynecology Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy.
⁹ Female External Genital Surgery Unit, Division of Gynecological Oncology, Department of Women's, Children's and Public Health Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy.
¹⁰ Gynecologic Oncology Unit, Centro di Riferimento Oncologico, National Cancer Institute, 33081 Aviano, Italy.
¹¹ Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, 00185 Rome, Italy.
¹² Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, 60121 Ancona, Italy.
¹³ Department of Obstetrics and Gynecology, Cannizzaro Hospital, University of Enna "Kore" (D'Agate and Scibilia), 95126 Catania, Italy.

PMID: 39857968
PMCID: PMC11764181
DOI: 10.3390/cancers17020186

Review

Management of Patients with Vulvar Cancers: A Systematic Comparison of International Guidelines (NCCN-ASCO-ESGO-BGCS-IGCS-FIGO-French Guidelines-RCOG)

Stefano Restaino et al. Cancers (Basel). 2025.

. 2025 Jan 8;17(2):186.

doi: 10.3390/cancers17020186.

Authors

Affiliations

¹ Clinic of Obstetrics and Gynecology, "Santa Maria della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy.
² PhD School in Biomedical Sciences, Gender Medicine, Child and Women Health, University of Sassari, 07100 Sassari, Italy.
³ Department of Medicine, University of Udine, 33100 Udine, Italy.
⁴ Gynaecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy.
⁵ Department of Medical Sciences, Obstetrics and Gynecology Unit, University of Ferrara, 44121 Ferrara, Italy.
⁶ Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy.
⁷ Unit of Gynecologic Oncology, National Cancer Institute, IRCCS, Fondazione "G. Pascale", 80131 Naples, Italy.
⁸ Department of Women's, Child and Public Health Sciences, UOC Gynecology Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy.
⁹ Female External Genital Surgery Unit, Division of Gynecological Oncology, Department of Women's, Children's and Public Health Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy.
¹⁰ Gynecologic Oncology Unit, Centro di Riferimento Oncologico, National Cancer Institute, 33081 Aviano, Italy.
¹¹ Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, 00185 Rome, Italy.
¹² Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, 60121 Ancona, Italy.
¹³ Department of Obstetrics and Gynecology, Cannizzaro Hospital, University of Enna "Kore" (D'Agate and Scibilia), 95126 Catania, Italy.

PMID: 39857968
PMCID: PMC11764181
DOI: 10.3390/cancers17020186

Abstract

Background: Vulvar carcinoma is an uncommon gynecological tumor primarily affecting older women. Its treatment significantly impacts the quality of life and, not least, aesthetics because of the mutilating surgery it requires.

Objectives: The management requires a multidisciplinary team of specialists who know how to care for the patient in her entirety, not neglecting psychological aspects and reconstructive surgery. How do the guidelines address multidisciplinarity, team surgical management, passing through preoperative diagnosis, and follow-up in such a challenging rare tumor to treat?

Methods: To answer these questions, we compared the main scientific recommendations to identify similarities and differences in diagnostic and therapeutic management to provide an overview of the gaps that there are currently in European and American international recommendations in providing management guidance in a cancer that is both among the rarest and most difficult to manage. In this way, we aim to encourage an update in practices based on the latest scientific evidence.

Results: A review of various international guidelines, some dating back to 2014, shows significant variation in approaches, ranging from initial diagnostic procedures to managing relapses. The most recent guidelines also lacked references to the latest literature, indicating that more robust scientific evidence is needed before new treatments, such as electrochemotherapy for palliation and reconstructive surgery post exenteration, can be widely adopted.

Conclusions: From the systematic comparison of the main international guidelines, a strong heterogeneity emerged in the diagnostic and therapeutic recommendations as well as for the multidisciplinary approach that today is essential. Our work certainly stimulated an update of the main guidelines.

Keywords: disease management; guidelines; review literature; vulvar cancer.

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Conflict of interest statement

The authors declare no conflicts of interest.

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References

1. World Health Organization International Agency for Research on Cancer. Cancer Today. [(accessed on 8 August 2024)]. Available online: https://gco.iarc.fr/today/data/factsheets/cancers/21-Vulva-fact-sheet.pdf.
1. SEER Cancer Statistics Factsheets: Vulvar Cancer. Bethesda, MD: National Cancer Institute. [(accessed on 8 November 2023)]; Available online: http://seer.cancer.gov/statfacts/html/vulva.html.
1. Darwish A., Ismail L., Manek S., Hellner K., Kehoe S., Majd H.S. Prognostic characteristics, recurrence patterns, and survival outcomes of vulval squamous cell carcinoma—A twelve-year retrospective analysis of a tertiary centre. Eur. J. Surg. Oncol. 2024;50:108447. doi: 10.1016/j.ejso.2024.108447. - DOI - PubMed
1. Stroup A.M., Harlan L.C., Trimble E.L. Demographic, clinical, and treatment trends among women diagnosed with vulvar cancer in the United States. Gynecol. Oncol. 2008;108:577–583. doi: 10.1016/j.ygyno.2007.11.011. - DOI - PMC - PubMed
1. Abu-Rustum N.R., Yashar C.M., Arend R., Barber E., Bradley K., Brooks R., Campos S.M., Chino J., Chon H.S., Crispens M.A., et al. Vulvar Cancer, Version 3.2024, NCCN Clinical Practice Guidelines in Oncology. J. Natl. Compr. Cancer Netw. 2024;22:117–135. doi: 10.6004/jnccn.2024.0013. - DOI - PubMed

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Management of Patients with Vulvar Cancers: A Systematic Comparison of International Guidelines (NCCN-ASCO-ESGO-BGCS-IGCS-FIGO-French Guidelines-RCOG)

Affiliations

Management of Patients with Vulvar Cancers: A Systematic Comparison of International Guidelines (NCCN-ASCO-ESGO-BGCS-IGCS-FIGO-French Guidelines-RCOG)

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