title: Adjuvant therapy in lymph node-positive vulvar cancer: the AGO-CaRE-1 study.
abstract: BACKGROUND
  Women with node-positive vulvar cancer have a high risk for disease recurrence. Indication criteria for adjuvant radiotherapy are controversial. This study was designed to further understand the role of adjuvant therapy in node-positive disease.
  
  
  METHODS
  Patients with primary squamous-cell vulvar cancer treated at 29 gynecologic cancer centers in Germany from 1998 through 2008 were included in this retrospective exploratory multicenter cohort study. Of 1618 documented patients, 1249 had surgical groin staging and known lymph node status and were further analyzed. All statistical tests were two-sided.
  
  
  RESULTS
  Four hundred forty-seven of 1249 patients (35.8%) had lymph node metastases (N+). The majority of N+ patients had one (172 [38.5%]) or two (102 [22.8%]) positive nodes. The three-year progression-free survival (PFS) rate of N+ patients was 35.2%, and the overall survival (OS) rate 56.2% compared with 75.2% and 90.2% in node-negative patients (N-). Two hundred forty-four (54.6%) N+ patients had adjuvant therapy, of which 183 (40.9%) had radiotherapy directed at the groins (+/-other fields). Three-year PFS and OS rates in these patients were better compared with N+ patients without adjuvant treatment (PFS: 39.6% vs 25.9%, hazard ratio [HR] = 0.67, 95% confidence interval [CI[= 0.51 to 0.88, P = .004; OS: 57.7% vs 51.4%, HR = 0.79, 95% CI = 0.56 to 1.11, P = .17). This effect was statistically significant in multivariable analysis adjusted for age, Eastern Cooperative Oncology Group, Union internationale contre le cancer stage, grade, invasion depth, and number of positive nodes (PFS: HR = 0.58, 95% CI = 0.43 to 0.78, P < .001; OS: HR = 0.63, 95% CI = 0.43 to 0.91, P = .01).
  
  
  CONCLUSIONS
  This large multicenter study in vulvar cancer observed that adjuvant radiotherapy was associated with improved prognosis in node-positive patients and will hopefully help to overcome concerns regarding adjuvant treatment. However, outcome after adjuvant radiotherapy remains poor compared with node-negative patients. Adjuvant chemoradiation could be a possible strategy to improve therapy because it is superior to radiotherapy alone in other squamous cell carcinomas.
authors.affiliation: Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (SM, LFG, LW); Department of Obstetrics and Gynecology, University Hospital Munich Maistrasse, Munich, Germany (JJ); Department of Obstetrics and Gynecology, University Medical Center Kiel, Kiel, Germany (FH); KKS Philipps University Marburg, Marburg, Germany (PN); Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany (PH, AdB); Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany (NdG); Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany (AHas); Department of Gynecology, Charité University Medicine Berlin Campus Virchow, Berlin, Germany (JS); Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany (AHab); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (PH); Department of Obstetrics and Gynecology, Grosshadern University Hospital, Munich, Germany (SF); Department of Gynecology, University Hospital Halle, Halle, Germany (HGS); Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany (KB); Department of Gynecology, University Hospital Erlangen, Erlangen, Germany (FT); Department of Obstetrics and Gynecology, University Hospital Greifswald, Greifswald, Germany (AM); Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany (WM).
authors.forename: Sven
authors.initials: S
authors.lastname: Mahner
authors.affiliation: Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (SM, LFG, LW); Department of Obstetrics and Gynecology, University Hospital Munich Maistrasse, Munich, Germany (JJ); Department of Obstetrics and Gynecology, University Medical Center Kiel, Kiel, Germany (FH); KKS Philipps University Marburg, Marburg, Germany (PN); Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany (PH, AdB); Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany (NdG); Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany (AHas); Department of Gynecology, Charité University Medicine Berlin Campus Virchow, Berlin, Germany (JS); Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany (AHab); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (PH); Department of Obstetrics and Gynecology, Grosshadern University Hospital, Munich, Germany (SF); Department of Gynecology, University Hospital Halle, Halle, Germany (HGS); Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany (KB); Department of Gynecology, University Hospital Erlangen, Erlangen, Germany (FT); Department of Obstetrics and Gynecology, University Hospital Greifswald, Greifswald, Germany (AM); Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany (WM).
authors.forename: Julia
authors.initials: J
authors.lastname: Jueckstock
authors.affiliation: Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (SM, LFG, LW); Department of Obstetrics and Gynecology, University Hospital Munich Maistrasse, Munich, Germany (JJ); Department of Obstetrics and Gynecology, University Medical Center Kiel, Kiel, Germany (FH); KKS Philipps University Marburg, Marburg, Germany (PN); Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany (PH, AdB); Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany (NdG); Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany (AHas); Department of Gynecology, Charité University Medicine Berlin Campus Virchow, Berlin, Germany (JS); Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany (AHab); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (PH); Department of Obstetrics and Gynecology, Grosshadern University Hospital, Munich, Germany (SF); Department of Gynecology, University Hospital Halle, Halle, Germany (HGS); Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany (KB); Department of Gynecology, University Hospital Erlangen, Erlangen, Germany (FT); Department of Obstetrics and Gynecology, University Hospital Greifswald, Greifswald, Germany (AM); Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany (WM).
authors.forename: Felix
authors.initials: F
authors.lastname: Hilpert
authors.affiliation: Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (SM, LFG, LW); Department of Obstetrics and Gynecology, University Hospital Munich Maistrasse, Munich, Germany (JJ); Department of Obstetrics and Gynecology, University Medical Center Kiel, Kiel, Germany (FH); KKS Philipps University Marburg, Marburg, Germany (PN); Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany (PH, AdB); Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany (NdG); Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany (AHas); Department of Gynecology, Charité University Medicine Berlin Campus Virchow, Berlin, Germany (JS); Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany (AHab); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (PH); Department of Obstetrics and Gynecology, Grosshadern University Hospital, Munich, Germany (SF); Department of Gynecology, University Hospital Halle, Halle, Germany (HGS); Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany (KB); Department of Gynecology, University Hospital Erlangen, Erlangen, Germany (FT); Department of Obstetrics and Gynecology, University Hospital Greifswald, Greifswald, Germany (AM); Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany (WM).
authors.forename: Petra
authors.initials: P
authors.lastname: Neuser
authors.affiliation: Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (SM, LFG, LW); Department of Obstetrics and Gynecology, University Hospital Munich Maistrasse, Munich, Germany (JJ); Department of Obstetrics and Gynecology, University Medical Center Kiel, Kiel, Germany (FH); KKS Philipps University Marburg, Marburg, Germany (PN); Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany (PH, AdB); Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany (NdG); Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany (AHas); Department of Gynecology, Charité University Medicine Berlin Campus Virchow, Berlin, Germany (JS); Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany (AHab); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (PH); Department of Obstetrics and Gynecology, Grosshadern University Hospital, Munich, Germany (SF); Department of Gynecology, University Hospital Halle, Halle, Germany (HGS); Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany (KB); Department of Gynecology, University Hospital Erlangen, Erlangen, Germany (FT); Department of Obstetrics and Gynecology, University Hospital Greifswald, Greifswald, Germany (AM); Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany (WM).
authors.forename: Philipp
authors.initials: P
authors.lastname: Harter
authors.affiliation: Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (SM, LFG, LW); Department of Obstetrics and Gynecology, University Hospital Munich Maistrasse, Munich, Germany (JJ); Department of Obstetrics and Gynecology, University Medical Center Kiel, Kiel, Germany (FH); KKS Philipps University Marburg, Marburg, Germany (PN); Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany (PH, AdB); Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany (NdG); Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany (AHas); Department of Gynecology, Charité University Medicine Berlin Campus Virchow, Berlin, Germany (JS); Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany (AHab); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (PH); Department of Obstetrics and Gynecology, Grosshadern University Hospital, Munich, Germany (SF); Department of Gynecology, University Hospital Halle, Halle, Germany (HGS); Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany (KB); Department of Gynecology, University Hospital Erlangen, Erlangen, Germany (FT); Department of Obstetrics and Gynecology, University Hospital Greifswald, Greifswald, Germany (AM); Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany (WM).
authors.forename: Nikolaus
authors.initials: N
authors.lastname: de Gregorio
authors.affiliation: Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (SM, LFG, LW); Department of Obstetrics and Gynecology, University Hospital Munich Maistrasse, Munich, Germany (JJ); Department of Obstetrics and Gynecology, University Medical Center Kiel, Kiel, Germany (FH); KKS Philipps University Marburg, Marburg, Germany (PN); Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany (PH, AdB); Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany (NdG); Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany (AHas); Department of Gynecology, Charité University Medicine Berlin Campus Virchow, Berlin, Germany (JS); Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany (AHab); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (PH); Department of Obstetrics and Gynecology, Grosshadern University Hospital, Munich, Germany (SF); Department of Gynecology, University Hospital Halle, Halle, Germany (HGS); Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany (KB); Department of Gynecology, University Hospital Erlangen, Erlangen, Germany (FT); Department of Obstetrics and Gynecology, University Hospital Greifswald, Greifswald, Germany (AM); Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany (WM).
authors.forename: Annette
authors.initials: A
authors.lastname: Hasenburg
authors.affiliation: Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (SM, LFG, LW); Department of Obstetrics and Gynecology, University Hospital Munich Maistrasse, Munich, Germany (JJ); Department of Obstetrics and Gynecology, University Medical Center Kiel, Kiel, Germany (FH); KKS Philipps University Marburg, Marburg, Germany (PN); Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany (PH, AdB); Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany (NdG); Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany (AHas); Department of Gynecology, Charité University Medicine Berlin Campus Virchow, Berlin, Germany (JS); Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany (AHab); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (PH); Department of Obstetrics and Gynecology, Grosshadern University Hospital, Munich, Germany (SF); Department of Gynecology, University Hospital Halle, Halle, Germany (HGS); Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany (KB); Department of Gynecology, University Hospital Erlangen, Erlangen, Germany (FT); Department of Obstetrics and Gynecology, University Hospital Greifswald, Greifswald, Germany (AM); Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany (WM).
authors.forename: Jalid
authors.initials: J
authors.lastname: Sehouli
authors.affiliation: Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (SM, LFG, LW); Department of Obstetrics and Gynecology, University Hospital Munich Maistrasse, Munich, Germany (JJ); Department of Obstetrics and Gynecology, University Medical Center Kiel, Kiel, Germany (FH); KKS Philipps University Marburg, Marburg, Germany (PN); Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany (PH, AdB); Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany (NdG); Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany (AHas); Department of Gynecology, Charité University Medicine Berlin Campus Virchow, Berlin, Germany (JS); Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany (AHab); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (PH); Department of Obstetrics and Gynecology, Grosshadern University Hospital, Munich, Germany (SF); Department of Gynecology, University Hospital Halle, Halle, Germany (HGS); Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany (KB); Department of Gynecology, University Hospital Erlangen, Erlangen, Germany (FT); Department of Obstetrics and Gynecology, University Hospital Greifswald, Greifswald, Germany (AM); Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany (WM).
authors.forename: Annika
authors.initials: A
authors.lastname: Habermann
authors.affiliation: Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (SM, LFG, LW); Department of Obstetrics and Gynecology, University Hospital Munich Maistrasse, Munich, Germany (JJ); Department of Obstetrics and Gynecology, University Medical Center Kiel, Kiel, Germany (FH); KKS Philipps University Marburg, Marburg, Germany (PN); Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany (PH, AdB); Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany (NdG); Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany (AHas); Department of Gynecology, Charité University Medicine Berlin Campus Virchow, Berlin, Germany (JS); Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany (AHab); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (PH); Department of Obstetrics and Gynecology, Grosshadern University Hospital, Munich, Germany (SF); Department of Gynecology, University Hospital Halle, Halle, Germany (HGS); Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany (KB); Department of Gynecology, University Hospital Erlangen, Erlangen, Germany (FT); Department of Obstetrics and Gynecology, University Hospital Greifswald, Greifswald, Germany (AM); Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany (WM).
authors.forename: Peter
authors.initials: P
authors.lastname: Hillemanns
authors.affiliation: Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (SM, LFG, LW); Department of Obstetrics and Gynecology, University Hospital Munich Maistrasse, Munich, Germany (JJ); Department of Obstetrics and Gynecology, University Medical Center Kiel, Kiel, Germany (FH); KKS Philipps University Marburg, Marburg, Germany (PN); Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany (PH, AdB); Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany (NdG); Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany (AHas); Department of Gynecology, Charité University Medicine Berlin Campus Virchow, Berlin, Germany (JS); Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany (AHab); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (PH); Department of Obstetrics and Gynecology, Grosshadern University Hospital, Munich, Germany (SF); Department of Gynecology, University Hospital Halle, Halle, Germany (HGS); Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany (KB); Department of Gynecology, University Hospital Erlangen, Erlangen, Germany (FT); Department of Obstetrics and Gynecology, University Hospital Greifswald, Greifswald, Germany (AM); Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany (WM).
authors.forename: Sophie
authors.initials: S
authors.lastname: Fuerst
authors.affiliation: Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (SM, LFG, LW); Department of Obstetrics and Gynecology, University Hospital Munich Maistrasse, Munich, Germany (JJ); Department of Obstetrics and Gynecology, University Medical Center Kiel, Kiel, Germany (FH); KKS Philipps University Marburg, Marburg, Germany (PN); Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany (PH, AdB); Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany (NdG); Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany (AHas); Department of Gynecology, Charité University Medicine Berlin Campus Virchow, Berlin, Germany (JS); Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany (AHab); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (PH); Department of Obstetrics and Gynecology, Grosshadern University Hospital, Munich, Germany (SF); Department of Gynecology, University Hospital Halle, Halle, Germany (HGS); Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany (KB); Department of Gynecology, University Hospital Erlangen, Erlangen, Germany (FT); Department of Obstetrics and Gynecology, University Hospital Greifswald, Greifswald, Germany (AM); Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany (WM).
authors.forename: Hans-Georg
authors.initials: HG
authors.lastname: Strauss
authors.affiliation: Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (SM, LFG, LW); Department of Obstetrics and Gynecology, University Hospital Munich Maistrasse, Munich, Germany (JJ); Department of Obstetrics and Gynecology, University Medical Center Kiel, Kiel, Germany (FH); KKS Philipps University Marburg, Marburg, Germany (PN); Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany (PH, AdB); Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany (NdG); Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany (AHas); Department of Gynecology, Charité University Medicine Berlin Campus Virchow, Berlin, Germany (JS); Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany (AHab); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (PH); Department of Obstetrics and Gynecology, Grosshadern University Hospital, Munich, Germany (SF); Department of Gynecology, University Hospital Halle, Halle, Germany (HGS); Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany (KB); Department of Gynecology, University Hospital Erlangen, Erlangen, Germany (FT); Department of Obstetrics and Gynecology, University Hospital Greifswald, Greifswald, Germany (AM); Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany (WM).
authors.forename: Klaus
authors.initials: K
authors.lastname: Baumann
authors.affiliation: Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (SM, LFG, LW); Department of Obstetrics and Gynecology, University Hospital Munich Maistrasse, Munich, Germany (JJ); Department of Obstetrics and Gynecology, University Medical Center Kiel, Kiel, Germany (FH); KKS Philipps University Marburg, Marburg, Germany (PN); Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany (PH, AdB); Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany (NdG); Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany (AHas); Department of Gynecology, Charité University Medicine Berlin Campus Virchow, Berlin, Germany (JS); Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany (AHab); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (PH); Department of Obstetrics and Gynecology, Grosshadern University Hospital, Munich, Germany (SF); Department of Gynecology, University Hospital Halle, Halle, Germany (HGS); Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany (KB); Department of Gynecology, University Hospital Erlangen, Erlangen, Germany (FT); Department of Obstetrics and Gynecology, University Hospital Greifswald, Greifswald, Germany (AM); Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany (WM).
authors.forename: Falk
authors.initials: F
authors.lastname: Thiel
authors.affiliation: Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (SM, LFG, LW); Department of Obstetrics and Gynecology, University Hospital Munich Maistrasse, Munich, Germany (JJ); Department of Obstetrics and Gynecology, University Medical Center Kiel, Kiel, Germany (FH); KKS Philipps University Marburg, Marburg, Germany (PN); Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany (PH, AdB); Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany (NdG); Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany (AHas); Department of Gynecology, Charité University Medicine Berlin Campus Virchow, Berlin, Germany (JS); Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany (AHab); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (PH); Department of Obstetrics and Gynecology, Grosshadern University Hospital, Munich, Germany (SF); Department of Gynecology, University Hospital Halle, Halle, Germany (HGS); Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany (KB); Department of Gynecology, University Hospital Erlangen, Erlangen, Germany (FT); Department of Obstetrics and Gynecology, University Hospital Greifswald, Greifswald, Germany (AM); Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany (WM).
authors.forename: Alexander
authors.initials: A
authors.lastname: Mustea
authors.affiliation: Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (SM, LFG, LW); Department of Obstetrics and Gynecology, University Hospital Munich Maistrasse, Munich, Germany (JJ); Department of Obstetrics and Gynecology, University Medical Center Kiel, Kiel, Germany (FH); KKS Philipps University Marburg, Marburg, Germany (PN); Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany (PH, AdB); Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany (NdG); Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany (AHas); Department of Gynecology, Charité University Medicine Berlin Campus Virchow, Berlin, Germany (JS); Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany (AHab); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (PH); Department of Obstetrics and Gynecology, Grosshadern University Hospital, Munich, Germany (SF); Department of Gynecology, University Hospital Halle, Halle, Germany (HGS); Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany (KB); Department of Gynecology, University Hospital Erlangen, Erlangen, Germany (FT); Department of Obstetrics and Gynecology, University Hospital Greifswald, Greifswald, Germany (AM); Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany (WM).
authors.forename: Werner
authors.initials: W
authors.lastname: Meier
authors.affiliation: Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (SM, LFG, LW); Department of Obstetrics and Gynecology, University Hospital Munich Maistrasse, Munich, Germany (JJ); Department of Obstetrics and Gynecology, University Medical Center Kiel, Kiel, Germany (FH); KKS Philipps University Marburg, Marburg, Germany (PN); Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany (PH, AdB); Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany (NdG); Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany (AHas); Department of Gynecology, Charité University Medicine Berlin Campus Virchow, Berlin, Germany (JS); Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany (AHab); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (PH); Department of Obstetrics and Gynecology, Grosshadern University Hospital, Munich, Germany (SF); Department of Gynecology, University Hospital Halle, Halle, Germany (HGS); Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany (KB); Department of Gynecology, University Hospital Erlangen, Erlangen, Germany (FT); Department of Obstetrics and Gynecology, University Hospital Greifswald, Greifswald, Germany (AM); Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany (WM).
authors.forename: Andreas
authors.initials: A
authors.lastname: du Bois
authors.affiliation: Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (SM, LFG, LW); Department of Obstetrics and Gynecology, University Hospital Munich Maistrasse, Munich, Germany (JJ); Department of Obstetrics and Gynecology, University Medical Center Kiel, Kiel, Germany (FH); KKS Philipps University Marburg, Marburg, Germany (PN); Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany (PH, AdB); Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany (NdG); Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany (AHas); Department of Gynecology, Charité University Medicine Berlin Campus Virchow, Berlin, Germany (JS); Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany (AHab); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (PH); Department of Obstetrics and Gynecology, Grosshadern University Hospital, Munich, Germany (SF); Department of Gynecology, University Hospital Halle, Halle, Germany (HGS); Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany (KB); Department of Gynecology, University Hospital Erlangen, Erlangen, Germany (FT); Department of Obstetrics and Gynecology, University Hospital Greifswald, Greifswald, Germany (AM); Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany (WM).
authors.forename: Lis-Femke
authors.initials: LF
authors.lastname: Griebel
authors.affiliation: Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (SM, LFG, LW); Department of Obstetrics and Gynecology, University Hospital Munich Maistrasse, Munich, Germany (JJ); Department of Obstetrics and Gynecology, University Medical Center Kiel, Kiel, Germany (FH); KKS Philipps University Marburg, Marburg, Germany (PN); Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany (PH, AdB); Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany (NdG); Department of Gynecology and Gynecologic Oncology, University Hospital Freiburg, Freiburg, Germany (AHas); Department of Gynecology, Charité University Medicine Berlin Campus Virchow, Berlin, Germany (JS); Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany (AHab); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (PH); Department of Obstetrics and Gynecology, Grosshadern University Hospital, Munich, Germany (SF); Department of Gynecology, University Hospital Halle, Halle, Germany (HGS); Department of Gynecology and Gynecologic Oncology, Philipps University Marburg, Marburg, Germany (KB); Department of Gynecology, University Hospital Erlangen, Erlangen, Germany (FT); Department of Obstetrics and Gynecology, University Hospital Greifswald, Greifswald, Germany (AM); Department of Obstetrics and Gynecology, Evangelical Hospital Duesseldorf, Duesseldorf, Germany (WM).
authors.forename: Linn
authors.initials: L
authors.lastname: Woelber
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000473:pathology* / Q000532:radiotherapy*; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D005858:Germany; D006119:Groin; D006801:Humans; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016896:Treatment Outcome; D014846:Vulvar Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*