title: Primary groin irradiation vs primary groin surgery for early vulvar cancer.
abstract: BACKGROUND
  Despite changes in technique, morbidity after surgical treatment for vulvar cancer is considerable and mainly related to the groin dissection. Primary radiotherapy to the groin is expected to result in lower morbidity. However, studies on the efficacy of primary radiotherapy for the groins in terms of groin recurrences and survival show conflicting results.
  
  
  OBJECTIVE
  To determine whether the effectiveness and safety of primary radiotherapy to the inguino-femoral lymph nodes is comparable with surgery
  
  
  METHODS
  The literature search was carried out using the criteria set by the Cochrane Gynaecological Cancer Group. A MEDLINE and EMBASE search using the Mesh Heading 'vulvar neoplasms' and textword 'vulva' was performed. Publications on the effectiveness of primary radiotherapy treatment of early squamous cell carcinoma of the vulva were selected.
  
  
  METHODS
  
  
  
  METHODS
  Randomized clinical trials, case-control and observational studies of primary radiotherapy of the groin Type of participants: Patients with early squamous cell cancer of the vulva Type of interventions: inguino-femoral lymph node dissection and primary radiotherapy of the inguino-femoral lymph nodes. Type of outcome measurements: incidence of groin recurrences, survival and morbidity
  
  
  METHODS
  Two reviewers independently assessed study quality and extracted results
  
  
  RESULTS
  Out of nine reviewed papers only three met the selection criteria. From these studies, (one randomised controlled trial [RCT] one case-control and one observational study) it became clear from the RCT that the incidence of groin recurrences after primary radiotherapy is higher compared with surgery. survival was also worse in the radiotherapy group. The other two studies showed a higher than expected number of groin recurrences after primary radiotherapy. Morbidity after primary radiotherapy was lower compared with surgery. The conclusion of the RCT was criticized on the grounds of the depth of the radiotherapy administered. The depth of 3 cm used in the RCT, is too shallow to administer an optimal dose to the deeper groin nodes.
  
  
  CONCLUSIONS
  As shown in an RCT, primary radiotherapy to the groin results in less morbidity but also in a higher number of groin recurrences compared with surgery. Although the technique of radiotherapy in the RCT was criticized, other uncontrolled data do not give evidence for a similar or better groin control for radiotherapy when compared to surgery. This means that surgery is still to be considered the cornerstone of therapy for the groin nodes in women with vulvar cancer. Individual patients not fit enough to withstand surgery can be treated with primary radiotherapy.
authors.affiliation: Division of Obstetrics and Gynaecology, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands. j.vandervelden@amc.uva.nl
authors.forename: K
authors.initials: K
authors.lastname: van der Velden
authors.forename: A
authors.initials: A
authors.lastname: Ansink
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D007264:Inguinal Canal; D008198:Lymph Nodes; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D016032:Randomized Controlled Trials as Topic; D014846:Vulvar Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*