title: Clinical management of primary vulvar cancer.
abstract: OBJECTIVE
  Vulvar cancer is a rare disease with increasing incidence over the last decades. Treatment includes surgical, radio- and chemotherapeutical options; however, due to the low incidence of the disease and the lack of randomised trials many questions regarding indication of different treatment approaches remain unanswered. This article discusses the current literature to elaborate recommendations for the management of primary vulvar cancer in clinical routine.
  
  
  METHODS
  We reviewed the available literature on treatment of invasive vulvar cancer with emphasis on therapeutic strategies such as surgery and radio/chemotherapy.
  
  
  RESULTS
  Surgery of the primary tumour and the groins remain the cornerstone of treatment in vulvar cancer with a strong trend towards a less radical approach in early stage disease. Complete vulvectomy was replaced by radical local excision with plastic reconstruction and the sentinel node technique was implemented to avoid the morbidity of complete groin dissection in node negative patients. In patients with advanced primary disease, treatment decisions are still a challenge. Criteria for the indication and performance of chemo/radiotherapy of the vulva/groins/pelvis are still not fully established and vary between different countries and institutions due to the low level of evidence. Often an individualised therapeutic approach aside from guidelines is necessary to treat these patients adequately.
  
  
  CONCLUSIONS
  To enable reasonable treatment decisions and avoid unnecessary morbidity, treatment in specialised centres should be intended at any time. Clinical studies performed by several study groups on an international level are urgently needed to further improve therapy.
authors: Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany. lwoelber@uke.uni-hamburg.de
authors: Linn
authors: L
authors: Woelber
authors: Lilli
authors: L
authors: Kock
authors: Friederike
authors: F
authors: Gieseking
authors: Cordula
authors: C
authors: Petersen
authors: Fabian
authors: F
authors: Trillsch
authors: Matthias
authors: M
authors: Choschzick
authors: Fritz
authors: F
authors: Jaenicke
authors: Sven
authors: S
authors: Mahner
mesh_terms: D059186:Chemoradiotherapy, Adjuvant; D019317:Evidence-Based Medicine; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008197:Lymph Node Excision; D017410:Practice Guidelines as Topic; D018714:Radiotherapy, Adjuvant; D016896:Treatment Outcome; D014846:Vulvar Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*