title: The effect of groin treatment modality and sequence on clinically significant chronic lymphedema in patients with vulvar carcinoma.
abstract: OBJECTIVE
  Chronic lymphedema (CL) after inguinal lymph node dissection (ILND) or radiotherapy (RT) is a significant problem for vulvar cancer survivors. The treatment modality or combination of therapies that poses the greatest risk is not known. The objective of this study was to describe rates of clinically significant CL conferred by different groin treatment modalities.
  
  
  METHODS
  Medical records of vulvar cancer patients who had groin treatment with ILND, RT, or both were retrospectively reviewed. Each treated groin was considered individually, and divided into 4 treatment groups: ILND alone, ILND with adjuvant RT, neoadjuvant chemoradiation therapy (NCRT), or NCRT followed by ILND. Clinically significant CL was defined as that which required treatment and was recorded by laterality. Differences among groups were evaluated with χ(2) and Fisher exact test.
  
  
  RESULTS
  Between 2000 and 2010, 146 patients with vulvar cancer who underwent therapy to 1 or both groins were identified for a total of 266 treated groins. The rates of CL for single-modality treatment, ILND or NCRT, were 10.9% and 6.7%, respectively. Multimodal treatment resulted in higher rates of CL, 13.5% for ILND followed by RT and 17.2% for NCRT followed by ILND, although differences were not significant (P = 0.37).
  
  
  CONCLUSIONS
  Clinically significant CL was not different between treatment modalities in this study, but is underpowered. The results provide valuable information about treatment complications that will be useful for patient-centered counseling. Prospective evaluation of CL and its impact on quality of life is warranted.
authors.affiliation: *Division of Gynecologic Oncology, †Department of Obstetrics, Gynecology, and Reproductive Sciences, and ‡Department of Radiation Oncology, Magee Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Berger
authors.forename: Eirwen
authors.initials: E
authors.lastname: Scott
authors.forename: Paniti
authors.initials: P
authors.lastname: Sukumvanich
authors.forename: Ashlee
authors.initials: A
authors.lastname: Smith
authors.forename: Alexander
authors.initials: A
authors.lastname: Olawaiye
authors.forename: John
authors.initials: J
authors.lastname: Comerci
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Kelley
authors.forename: Sushil
authors.initials: S
authors.lastname: Beriwal
authors.forename: Marilyn
authors.initials: M
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000473:pathology / Q000628:therapy*; D002908:Chronic Disease; D003131:Combined Modality Therapy / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006119:Groin / Q000473:pathology*; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008209:Lymphedema / Q000209:etiology* / Q000473:pathology; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D014846:Vulvar Neoplasms / Q000150:complications / Q000473:pathology / Q000628:therapy*