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14 Treatment of recurrent disease

14.1 Summary of available scientific evidence

Chemoradiation: no studies enrolling at least 50 patients were identified. Results from the 8 LoE 3
identified studies227-230,241,244,251,252 are limited notably by the small number of patients evaluated
(only one study251 has accrued in excess of 20 patients) and by the heterogeneity in the

chemoradiation regimens (Table 14).

Chemotherapy: no studies enrolling at least 50 patients were identified. Results from the 7 identified LoE 3
trials257,259,264,267-270 are limited notably by the small number of patients evaluated (only 2 trials267,268

have accrued in excess of 20 patients) and by the heterogeneity in the chemotherapy regimens (Table

15).

14.2 Previous initiatives

Four previous initiatives1-3,39 presenting guidelines on treatment of recurrent disease were identified.

14.3 Development group comments

Local recurrences should be treated as primary tumours with wide local excision and inguinofemoral
lymphadenectomy in case of depth of invasion >1 mm and not performed previously.

CT thorax/abdomen or PET/CT thorax/abdomen is recommended to examine the presence of additional
metastases, which presence may influence treatment planning. Imaging might also be helpful in determining the
possibility of surgical resection.

14.4 Guidelines

Treatment of vulvar recurrence

 Radical local excision is recommended.

 For vulvar recurrence with a depth of invasion > 1 mm and previous sentinel lymph node removal
only, inguinofemoral lymphadenectomy should be performed.

 The indications for postoperative radiotherapy are comparable to those for the treatment of primary
disease.

Treatment of groin recurrence

 Restaging by CT (or PET-CT) of the thorax/abdomen/pelvis is recommended.

 Preferred treatment is radical excision when possible, followed by postoperative radiation in
radiotherapy naïve patients.

 Based on evidence from other squamous cell cancers such as cervical and anal cancer, the addition of
radiosensitising chemotherapy to postoperative radiotherapy should be considered.

 Definitive chemoradiation when surgical treatment is not possible.

Treatment of distant metastases
 Systemic (palliative) therapy may be considered in individual patients (see systemic treatment).

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